SuperPATH微创技术在全髋关节置换术中的应用及近期疗效分析

目的 探讨SuperPATH微创技术在全髋关节置换术(THA)中的应用与近期疗效。方法 回顾性分析2016年6月—2018年3月四川大学华西医院金堂医院骨科行THA的153例(160髋)患者的临床资料和影像资料,其中男79例、女74例,年龄25~86(60.81±10.55)岁。左侧68例,右侧78例,双侧7例。按手术方式不同分为2组,其中采用SuperPATH微创入路(SuperPATH组)69例(72髋),采用传统后外侧入路(传统手术组)84例(88髋)。对比2组患者围术期一般情况、关节功能改善情况、实验室指标、影像学检查结果。结果 两组患者均顺利完成手术。SuperPATH组手术时间、切口长度、术中出血量、术后引流量、C反应蛋白、红细胞沉降量分别为(112.09±21.93)min、(8.45±1.10)cm、(243.18±66.00)mL、(186.36±65.80)mL、(84.07±51.69)mg/L和(46.95±19.58)mm/1h,传统手术组分别为(94.69±13.13)min、(14.69±1.41)cm、(290.38±69.31)mL、(240.38±61.68)mL、(134.72±57.51)mg/L和(64.05±27.17)mm/1h。两组间比较,SuperPATH组手术时间大于传统手术组,而切口长度、术中出血量、术后引流量、C反应蛋白、红细胞沉降率均小于传统手术组,差异均有统计学意义(t=3.636、16.703、2.822、3.069、2.922、2.339, P值均＜0.05)。153例(160髋)患者获得随访,随访时间为6~31个月,平均24个月。随访期间无一例患者出现假体周围骨折、感染、脱位等并发症。末次随访时,所有患者假体均未见松动下沉,未见透亮线及骨溶解发生;SuperPATH组屈髋和髋外展角度分别为118.18°±7.64°和42.95°±3.67°,大于传统手术组的110.77°±10.55°和38.08°±5.49°,差异均有统计学意义(t=3.881、3.022, P值均＜0.05);而VAS、Harris评分、髋臼外展角和前倾角,两组间差异均无统计学意义(P值均＞0.05)。SperPATH组1例(1髋)股骨柄轻度内翻,传统手术组股骨柄均为中立位植入,两组间比较差异无统计学意义(P＞0.05)。结论 与传统手术比较,采用SuperPATH微创入路行THA,尽管手术时间偏长,但可在术后最大限度地保留髋关节周围动力结构,减少手术创伤,增加关节活动度,符合目前髋关节外科微创化发展和加速康复理念的要求。

The early clinical outcomes of supercapsular percutaneouly-assisted total hip in total hip arthroplasty

Objective To investigate the early clinical outcomes of supercapsular percutaneously-assisted total hip (SuperPATH) in total hip arthropalasty (THA).Methods One hundred and fifty three patients(160 hips)received THA in West China Hospital affiliated Jing Tang Hospital from June 2016 to March 2018 were retrospectively analyzed. In total, 79 were males and 74 females, ranged from 25 to 86 years, mean (60.81±10.55) years. Left side were 68, right side were 78, bilateral side were 7. Patients were divided into two groups according to different surgical technique, one group was SuperPATH minimal invasive group (SuperPATH group), with 69 patients (72 hips), the other group was traditional posterior-lateral group (traditional group), with 84 patients (88 hips). The patients were followed and perioperative condition, joint function recovery, laboratory indexing and radiographic results were evaluated between the two groups.Results Patients in both groups were successfully performed the operation. The surgical time, incision length, blood loss during operation, postoperative drainage amount, CRP and ESR for patients in SuperPATH group were (112.09±21.93) min, (8.45±1.10) cm, (243.18±66.00) mL, (186.36±65.80) mL, (84.07±51.69) mg/L and (46.95±19.58)mm/L, which were (94.69±13.13)min, (14.69±1.41)cm, (290.38±69.31)mL, (240.38±61.68) mL, (134.72±57.51) mg/L and (64.05±27.17) mm/L in the traditional group, respectively. There were statistical differences in two groups(t=3.636, 16.703, 2.822, 3.069, 2.922 , 2.339, all P values＜0.05). One hundred and fifty-three patients (160 hips) were followed up, the average follow-up time was 6-31 months, average of 24 months. No periprosthetic fracture, infection, and dislocation occurred in both the two groups. During the last follow up, no implant subsidence, radiolucent line and osteolysis were found in any patient. The hip flexion and abduction angle in SuperPATH group were 118.18°±7.64° and 42.95°±3.67°, respectively, which were significantly different compared with those in the traditional group 110.77°±10.55° and 38.08°±5.49° (t=3.881, 3.022, all P values＜0.05). No significant differences were found in terms of VAS, Harris scores, cup abduction angle and anteversion angle (all P values＞0.05). In the SperPATH group, 1 case (1 hip) had mild varus of femoral stalk. The femoral stems were in neutral position in the traditional operation group. There was no statistically significant difference between the two groups(P＞0.05).Conclusions Although showing longer surgical time, SuperPATH technique can reserve dynamic structure around hip, reduce surgical injury, improve hip stability and enhance patient recovery in the early follow-up period, which meet the requirement of minimal invasive surgery and enhanced recovery after surgery in hip arthroplasty field.