SuperPATH与后外侧入路行人工全髋关节置换术的随机对照研究  

Randomized controlled trial of comparison between the SuperPATH and posterolateral approaches in total hip arthroplasty

作　　者：欧阳晨波 王浩洋[1] 孟维锟 罗泽宇[1] 王端[1] 裴福兴[1] 周宗科[1] OUYANG Chenbo;WANG Haoyang;MENG Weikun;LUO Zeyu;WANG Duan;PEI Fuxing;ZHOU Zongke(Department of Orthopaedics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China;Department of Orthopaedics,Chengdu 363 Hospital of China Aviation Industry,Chengdu Sichuan,610041,P.R China)

机构地区：[1]四川大学华西医院骨科,成都610041 [2]中航工业成都363医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2018年第12期1500-1506,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的对SuperPATH入路与传统后外侧入路行人工全髋关节置换术(total hip arthroplasty,THA)的疗效进行比较。方法 2017年3月—5月,将24例拟行初次单侧THA的髋关节疾病患者纳入研究,随机分为两组(n=12),分别采用SuperPATH入路(SuperPATH组)及传统后外侧入路(对照组)进行关节置换。两组患者性别、年龄、体质量指数、疾病类型、合并基础疾病类型、美国麻醉医师协会(ASA)分级等一般资料比较,差异均无统计学意义(P>0.05)。记录两组手术时间、住院时间、切口长度以及手术相关并发症发生情况;手术前后血红蛋白和红细胞压积,计算总失血量及术中失血量;手术前后炎性反应指标(C反应蛋白、红细胞沉降率)、肌肉损伤指标(肌酸激酶),患者髋关节屈曲及外展活动度、髋关节功能Harris评分、疼痛视觉模拟评分(VAS);摄骨盆正位X线片观察假体位置。结果两组患者均获1年随访。与对照组相比,SuperPATH组手术时间明显延长(t=4.470,P=0.000)、手术切口缩短(t=–2.168,P=0.041),住院时间无显著差异(t=0.474,P=0.640)。SuperPATH组术中1例发生假体周围骨折;两组术后均无感染、下肢深静脉血栓形成等并发症发生。两组术中失血量及总失血量,术前及术后1、3 d血红蛋白和红细胞压积,术前及术后1、3、14 d C反应蛋白及红细胞沉降率比较,差异均无统计学意义(P>0.05)。SuperPATH组术后1、3 d肌酸激酶明显低于对照组(P<0.05),术前及术后14 d比较差异无统计学意义(P>0.05)。术后1、3 d SuperPATH组髋关节屈曲及外展活动度均优于对照组(P<0.05),但14 d、3个月、6个月及1年比较差异均无统计学意义(P>0.05)。SuperPATH组术后1、3 d Harris评分及VAS评分明显优于对照组(P<0.05),其余各时间点差异均无统计学意义(P>0.05)。术后1年复查X线片,两组前倾角及外展角比较差异无统计学意义(P>0.05)。随访期间两组假体均无松动、下沉。结论与后�Objective To evaluate the effectiveness of SuperPATH approach in total hip arthroplasty(THA)compared with conventional posterolateral approach. Methods Between March 2017 and May 2017, 24 patients who planned to have a unilateral THA were enrolled in the study and randomized into 2 groups. Twelve patients were treated with SuperPATH approach(SuperPATH group) and 12 patients with posterolateral approach(control group). There was no significant difference in gender, age, body mass index, the type of disease, complicating diseases, and American Society of Anesthesiologists grading between 2 groups(P>0.05). The operation time, length of stay, length of incision, and perioperative complications related to operation were recorded. The hemoglobin and hematocrit were recorded; the total blood loss and intraoperative blood loss were calculated. The inflammatory response indicators(C-reactive protein,erythrocyte sedimentation rate) and muscle damage index(creatine kinase) were recorded in both groups. The range of motion, functional score(Harris score), visual analogue scale(VAS) score, and prosthesis position were recorded.Results Patients in both groups were followed up 1 year. Compared with the control group, the operation time of the SuperPATH group was longer(t=4.470, P=0.000), and the incision was shorter(t=–2.168, P=0.041). There was no significant difference in length of stay between 2 groups(t=0.474, P=0.640). Periprosthetic fracture occurred in 1 case of the SuperPATH group. No other complications, such as infection or deep vein thrombosis, occurred in both groups.There was no significant difference in intraoperative blood loss, total blood loss, hemoglobin and hematocrit before operation and at 1 and 3 days after operation, and C-reactive protein and erythrocyte sedimentation rate before operation and at 1, 3, and 14 days between 2 groups(P>0.05). For creatine kinase, SuperPATH group at 1 and 3 days were lower than control group(P<0.05), while no significant difference was found between 2 groups before operati

关 键 词：人工全髋关节置换术 SuperPATH入路 后外侧入路 微创 

分 类 号：R687.4[医药卫生—骨科学]