45°侧卧位微创前外侧入路应用于全髋关节置换术短期结果  

Early results of total hip arthroplasty via mini-invasive anterolateral approach in 45° lateral position

作　　者：李之琛[1] Olivier Bringer 陈东峰[1] 赵杰 卢伟杰[1] 钱东阳[1] 严广斌[1] 陈玉书[1] 

机构地区：[1]广州医科大学附属第一医院关节外科,510120 [2]Boujan sur Libron,France Centre de Chirurgie Osteo-articulaire,Polyclinique Saint Privat,France,34760 [3]广东药科大学健康学院,广州510310

出　　处：《中华关节外科杂志（电子版）》2017年第6期569-574,共6页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：广东省省级科技计划项目(2013B021800306);广州市属高校科技计划项目(1201420096)

摘　　要：目的总结45°侧卧位下经微创前外侧入路(OCM)行全髋关节置换术的手术经验以及短期结果回顾。方法回顾性分析18例45°侧卧位经微创前外侧入路(OCM)行全髋关节置换术围手术期及1年随访结果,包括可视化疼痛评分(VAS)和髋关节Harris评分,血红蛋白下降值,异体输血率,住院时间等,进行影像学评价,测量髋臼假体外展角,前倾角以及股骨假体内外翻与沉降程度,并与同期常规后入路行全髋关节置换术组病例进行对照,采用独立样本t检验及卡方检验分别进行组间计量与计数资料比较。结果 OCM组术后48 h VAS评分,术后1周Harris评分,血红蛋白下降值,输血率,平均住院日均优于后入路组;术后1年OCM组平均Harris评分为(93.74±1.80),后入路组(92.24±2.76),差异有统计学意义(t=2.068,P<0.05)。两组病例均无并发症发生。两组间髋臼假体外展角,前倾角比较无差异,股骨假体沉降距离,内外翻角度无差异。结论经OCM入路全髋关节置换术围手术期疼痛轻,失血少,康复快,具有快速康复的优势,具有一定的临床应用前景,但仍需期待更多的前瞻性研究及远期效果报道。Objective To review the early result of total hip arthroplasty via mini-invasive anterolateral approach （ OCM ） and demonstrate the technique of the OCM approach at a 45°lateral position.Methods Eighteen cases of total hip arthroplasty via OCM approach in 45 °lateral position were retrospectively analyzed and compared with 32 cases of total hip arthroplasty via conventional posterior approach .Clinical results including VAS score ,Harris score at the time of peri-operation and one year follow-up were recorded and radiologic data such as abduction and antevesion of acetabular component ,varus/valgus position and subsidence of femur component were evaluated .Loss of hemoglobin ,rate of blood transfusion,hospital stays were also compared .Data were calculated with software Spss 19.0,independent t test and chi-square test were used .A P value 〈0.05 was considered to be significant .Results VAS score at 48 hour postoperative ,Harris score at one week postoperative ,hemoglobin loss ,blood transfusion rate,hospital stays of OCM group were significantly better than the posterior approach group .At the time of one year follow-up,Harris scores of OCM group and the posterior approach group were （ 93.74 ±1.80 ） and （92.24 ±2.76） respectively （t=2.068,P〈0.05）.Complication was not observed in the two series of cases and the difference of radiologic data was not found neither .Conclusion With the superiority in quick rehabilitation ,less pain and less blood loss ,OCM approach in total hip arthroplasty could be more acceptable in the future ,and more long term results and prospective clinical studies are expected .

关 键 词：髋 置换 并发症 

分 类 号：R687.4[医药卫生—骨科学]