SuperPATH与Hardinge入路全髋关节置换术早期临床疗效比较  

Comparison of early effectiveness between Super PATH approach and Hardinge approach in total hip arthroplasty

作　　者：颜廷题 田少奇[2] 王远贺[2] 杨旭[2] 李彤[3] 刘江俊 潘丕春[1] 王荣[1] 王丹丹[1] 孙康[2] 

机构地区：[1]青岛大学医学部,山东青岛266073 [2]青岛大学附属医院关节外科,山东青岛266000 [3]济南市第四人民医院普外二科,济南250031

出　　处：《中国修复重建外科杂志》2017年第1期17-24,共8页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较Super PATH入路与传统Hardinge入路行人工全髋关节置换术(total hip arthroplasty,THA)的早期临床疗效。方法将2015年5月—2016年3月收治的154例(173髋)符合选择标准的拟行初次THA患者纳入研究,随机分为两组:其中64例(70髋)采用Super PATH入路行THA(A组),90例(103髋)采用Hardinge入路行THA(B组)。两组患者性别、年龄、体质量指数、疾病类型、术前Harris髋关节评分(Harris hip score,HHS)等一般资料比较差异无统计学意义(P>0.05),具有可比性。观察并记录两组患者切口长度、手术时间、住院时间、术中失血量、术后引流量、术后下地时间、输血率及并发症等,比较两组术前及术后1、3 d,1、3、6、12、24周的HHS评分、疼痛视觉模拟评分(VAS);通过X线片测量相关参数对两组患者术后假体位置进行影像学评价。另外,对应用Super PATH技术以来的92例(100髋)THA进行群组分层分析。结果 A组手术切口长度、术后下地时间及住院时间均低于B组,手术时间、术中失血量、输血率均高于B组(P<0.05);两组术后引流量比较差异无统计学意义(t=1.901,P=0.071)。两组患者均获随访,随访时间6~15个月,平均9个月。A组术后1 d、3 d及1周VAS评分显著低于B组(P<0.05);A组术后1 d、3 d、1周及3周HHS评分显著高于B组(P<0.05)。术后24周两组外展角及外展角位于"安全区"的比例比较差异均无统计学意义(P>0.05);A组前倾角及双下肢长度差异大于B组,前倾角位于"安全区"的比例、偏心距及恢复率小于B组,差异均有统计学意义(P<0.05)。在Super PATH群组的分层分析中,前30髋手术时间、切口长度、术中出血量、输血率及术后1 d VAS评分均高于后70髋(P<0.05)。前30髋发生术中大粗隆骨折1例,术后发生髋关节脱位2例;后70髋均未发生术中及术后相关并发症。两组均无神经血管损伤,假体松动、感染,深静脉血栓形成等并发症发生。结论 Super PATH入路相对Objective To compare the early effectiveness between SuperPATH approach and traditional Hardinge approach in total hip arthroplasty （THA）. Methods Between May 2015 and March 2016, 154 patients （173 hips） undergoing initial THA were included. THA was performed by SuperPATH approach in 64 cases （70 hips） in group A and by traditional Hardinge approach in 90 cases （103 hips） in group B. There was no significant difference in gender,age, body mass index, type of disease, and Harris hip score （HHS） between 2 groups （P〉0.05）. The incision length, operation time, intraoperative blood loss, postoperative drainage volume, transfusion rate, ambulation time, length of stay, and complications were recorded. The HHS and visual analogue scale （VAS） were compared between 2 groups before operation and at 1 day, 3 days, 1 week, 3 weeks, 6 weeks, 12 weeks, and 24 weeks after operation. And the relative parameters were measured for imaging evaluation of prosthesis position. In addition, the stratification analysis was performed on 92 patients （100 hips） who received the SuperPATH technology. Results The incision length, ambulation time, and length of stay in group A were significantly less than those in group B （P〈0.05）; the operation time, transfusion rate, and intraoperative blood loss of group A were significantly higher than those of group B （P〈0.05）; and there was no significant difference in postoperative drainage volume between 2 groups （t=1.901, P=0.071）. The follow-up period was 6 to 15 months （mean, 9 months）. The VAS scores at 1 day, 3 days, and 1 week after operation in group A were significantly lower than those in group B （P〈0.05）, but the HHS scores at 1 day, 3 days, 1 week, and 3 weeks after operation in group A were significantly higher than those in group B （P〈0.05）. At 24 weeks after operation, the acetabular cup abduction and the proportion within the safe zone showed no significant difference between 2 groups （P〉0.05）; the anteversion angle

关 键 词：SuperPATH入路 Hardinge入路 微创 人工全髋关节置换术 快速康复 

分 类 号：R687.4[医药卫生—骨科学]