基于直接前侧入路微创技术的侧卧位全髋关节置换  

Total hip arthroplasty in lateral decubitus position based on direct anterior minimum invasive surgery

作　　者：叶山山 高辉[2] 张裕 何春耒[2] Ye Shan-shan;Gao Hui;Zhang Yu;He Chun-lei(Gannan Medical University,Ganzhou 341000,Jiangxi Province,China;Department of Orthopedics,First Affiliated Hospital,Gannan Medical University,Ganzhou 341000,Jiangxi Province,China)

机构地区：[1]赣南医学院,江西省赣州市341000 [2]赣南医学院第一附属医院骨科,江西省赣州市341000

出　　处：《中国组织工程研究》2018年第11期1647-1652,共6页Chinese Journal of Tissue Engineering Research

基　　金：江西省卫生和计划生育委员会计划项目(20175369);赣州市科技计划项目(GZ2016ZSF002)~~

摘　　要：背景:直接前侧入路微创全髋关节置换被称为是最符合微创手术标准的全髋关节置换技术,理论上有更低的并发症发生率。但是由于微创手术本身对技术的高要求,在该手术的学习曲线初期,并发症发生率很高。侧卧位直接前侧入路微创技术被认为能为术者提供更好的手术视角,从而降低并发症发生率。目的:通过临床对照研究,探索侧卧位直接前侧入路微创技术应用于全髋关节置换的可行性。方法:回顾性分析2013年4月至2016年4月赣南医学院第一附属医院骨科收治的62例直接前侧入路微创全髋关节置换患者,随机分为2组,其中侧卧位组31例,仰卧位组31例。统计并比较2组切口长度、手术时间、术中出血量、臼杯角度、住院时间以及术前、术后Harris评分、目测类比评分、SF-36评分,并记录术后1年并发症。结果与结论:(1)侧卧位组的手术时间长于仰卧位组,术中出血量大于仰卧位组(P<0.05);2组皮肤切口长度、住院时间差异无显著性意义(P>0.05);(2)2组术后并发症发生率差异无显著性意义(P>0.05);(3)2组臼杯前倾角及外展角差异无显著性意义(P>0.05);(4)2组术前、术后1年Harris评分、目测类比评分、SF-36生活质量评分相比,差异无显著性意义(P>0.05);(5)综上,直接前侧入路微创全髋关节置换可以在不依赖专用牵引床的情况下通过侧卧位方式完成,短期效果与仰卧位直接前侧入路微创全髋关节置换没有区别。BACKGROUND:Direct anterior minimum invasive surgery(DAMIS)total hip arthroplasty has been considered as the total hip arthroplasty that is most consistent with the minimally invasive standards.In theory,there is a low incidence of complications in the DAMIS total hip arthroplasty.However,because minimally invasive surgery demands high surgery skills,the incidence rate of complications is high in the early period of its learning curve.Lateral decubitus position DAMIS was considered to provide a better perspective,so that,the incidence of surgical complications may be reduced.OBJECTIVE:To explore the feasibility of lateral decubitus position DAMIS for total hip arthroplasty.METHODS:Totally 62 cases from the Department of Orthopedics,First Affiliated Hospital of Gannan Medical University between April 2013 and April 2016 were retrospectively analyzed,and randomly assigned to two groups:lateral decubitus position group(n=31)and supine position group(n=31).Incision length,operative time,intraoperative blood loss,acetabular cup angle,hospital stay,Harris scores,Visual Analogue Scale score,and SF-36 score were compared between the two groups.Complications at postoperative 1 year were recorded.RESULTS AND CONCLUSION:(1)Operative time was longer and intraoperative blood loss was more in the lateral decubitus position group than in the supine position group(P<0.05).There were no statistically significant differences in incision length and hospital stay between the two groups(P>0.05).(2)There were no significant differences in the incidence of postoperative complications between the two groups(P>0.05).(3)There were no significant differences in the anteversion and abduction angles of acetabular cup between the two groups(P>0.05).(4)There were no significant differences in Harris hip score,Visual Analogue Scale score,and SF-36 the quality of life scores between the two groups before surgery and 1 year after surgery(P>0.05).(5)In conclusion,DAMIS total hip arthroplasty can abandon special traction bed when patients are in lat

关 键 词：全髋关节置换 微创 直接前侧入路 并发症 侧卧位 功能恢复 骨科植入物 人工关节 关节成形术 置换 髋 仰卧位 外科手术 微创性 组织工程 

分 类 号：R318[医药卫生—生物医学工程]