后外侧小切口人工全髋关节置换体会

目的：探讨后外侧入路小切口髋关节置换术的手术技巧和临床效果。方法：选用2006年12月至2008年12月初次人工全髋关节置换病例共94例98髋，随机分为两组，后外侧小切口人工全髋关节置换组（A组）和常规后外侧切口人工全髋关节置换术组（B组）。A组采用后外侧小切口人路人工全髋关节置换术49例50髋，男26例，女23例，年龄37．0～95．0（平均68．9）岁；体质量指数（body mass index，BMI）20．3～29．7（平均25．4）kg／m2。B组采用常规后外侧切口人路人工全髋关节置换术45例48髋，男27例，女18例，年龄45．0～92．0（平均69．7）岁；BMI18．7～34．1（平均26．9）kg／m2。对两组病例切口长度、术中出血量、引流量、手术时间、术后Harris评分等进行比较。结果：A组手术切口长6．0～10．5（平均7．4）cm；平均术中出血量387．6（140．0～1000．0）mL，平均术后引流量143．1（60．0～375．0）mL，平均输血量77．6（0～400．0）mL，手术平均时间84．6（63．0～130．0）min，术后影像学髋臼杯外展角平均41．6°（38．0°-57．0°）。B组手术切口长15．0～23．0（平均20．0）cm，平均术中出血513．1（210．0～1350．0）mL，平均术后引流量152．3（70．0～520．0）mL，平均输血量142．2（0～800．0）mL，手术平均时间84．0（71．0～115．0）min，术后影像学髋臼杯外展角平均42．3°（37．0°-54．0°）。术后及随访两组假体位置良好，Harris评分均显著提高，两组全髋关节置换术后均未出现并发症。结论：后外侧小切口人工全髋关节置换技术在正确选择适应证、手术技巧娴熟等情况下，具有对软组织损伤小、皮肤瘢痕小等优点，在术后影像学评价、Harris评分等方面与常规后外侧切口人工全髋关节置换术无明显差异，患者对关节功能以及术后恢复情况满意。

Experience in posterolateral mini-incision total hip arthroplasty

Objective： To explore the surgical techniques in posterolateral mini-incision total hip arthroplasty and clinical efficacy. Methods： A total of 94 patients （98 hips） had posterolateral mini-incision total hip arthroplasty, from December 2006 to December 2008, and were randomly divided into a posterolateral miniincision total hip arthroplasty group （Group A） and a conventional group of posterolateral incision for total hip arthroplasty （Group B）. Forty-nine patients （50 hips） in Group A had posterolateral small incision total hip arthroplasty 26 males, 23 females, between 37.0 and 95.0 years （average 68.9 years）, body mass index （BMI） between 20.3 and 29.7 （average BMI 25.4）]. Forty-five patients （48 hips） in Group B had the conventional posterolateral incision 27 males, 18 females, between 45.0 and 92.0 years （average 69.7 years）, BMI between 18.7 and 34.1 （average BMI 26.9）1. The incision length, blood loss, drainage, operation time, and postoperative Harris scores were compared between the 2 groups. Results： The incision length was 6.0-10.5 （average length 7.4） cm, average blood loss was 387.6 （140.0-1000.0） mL, average drainage was 143.1 （63.0-375.0） mL, average blood transfusion was 77.6 （0-400.0） mL, average operation time was 84.6 （63.0-130.0） min, and vitalock abduction angle imaging after the operation was 41.6° （averagely 38.0°-57.0°） in Group A. The incision length was 15.0-23.0 （average length 20.0） cm, average blood loss was 513.1 （210.0-1350.0） mL, average drainage was 152.3 （70.0-520.0） mL, average blood transfusion was 142.2 （0-800.0） mL, average operation time was 84.0 （71.0-115.0） min, and postoperative radiographic acetabular cup abduction angle was 42.3° （37.0°-54.0°） in Group B. The follow-up showed that the prosthesis of the 2 groups was in a good position, Harris score was significantly improved with no complications after total hip arthroplasty in the 2 groups. Conclusion： With the correct selection of indications and adept operation skills and other circumstances, posterolateral mini-incision total hip arthroplasty may do little damage to the soft tissue with a small scar on the skin. The imaging evaluation after the operation and the Harris score show no difference between the 2 groups. Patients are satisfied with their joint function and postoperative recovery.