改良小切口与常规全髋关节置换术的比较研究.docVIP

改良小切口与常规全髋关节置换术的比较研究 　　作者：叶小雨，赖宪良，沈新升，张长松 作者单位：(温州市中西医结合医院骨科，浙江 温州 325000) 　　【摘要】 目的 比较改良小切口与常规全髋关节置换术的手术经验及短期临床随访结果。方法 采用改良小切口对15 例15 髋进行全髋关节置换术(total hip arthroplosty，THA)，男10 例，女5 例;年龄65～75 岁，平均72 岁，体重指数20.5～26.5 kg/m2，平均23.5 kg/m2。股骨颈骨折10 例，股骨头缺血性坏死3 例，骨关节炎2 例。术前Harris评分平均33.5 分。同期采用常规后外侧入路行THA 15 例15 髋，男11 例，女4 例;年龄66～78 岁，平均73 岁，体重指数20.8～25.8 kg/m2，平均23.8 kg/m2。股骨颈骨折12 例，股骨头缺血性坏死3 例。术前Harris评分平均33.8 分。两组年龄、性别及体重指数均衡(P0.05)，疾病谱相似。对两组病例的术中出血量、手术时间、切口长度、术后早中期的功能锻炼情况及影像学评价进行比较。结果 术后随访6～10个月，平均8.2个月。改良小切口THA组切口长度平均9.5 cm，较常规THA组短(P0.05);术中出血量(318±223.1) mL，引流量(252±169.1) mL，均较常规THA组少(P0.05);平均手术时间两组并无统计学意义。小切口THA组术后早期功能恢复较常规THA组快，而中期结果相似。术后及随访时两组假体位置均良好。小切口THA组除有2 例患者术中发生切口近端皮肤擦伤，无并发症，常规THA组有1 例患者术后脱位。结论 改良小切口技术可选择性用于部分病例的人工全髋关节置换术，创伤小，围手术期出血少，切口小且不影响假体位置，术后早期功能锻炼。但应严格选择手术适应证，由拥有相应设备条件的医院及有一定经验的医生开展。 　　【关键词】 关节成形术;置换;髋;外科手术;小切口;随访研究 　　Retrospective Comparison of Total Hip Arthroplasty Through a Modified Miniincision Versus Standard Posterolateral Approach 　　YE Xiaoyu，LAI Xianliang，SHEN Xinsheng，et al 　　(Department of Orthopaedics，Wenzhou Hospital of Chinese Traditional Combined Western Medicine，Wenzhou 325000，China) 　　Abstract：Objective To summarize and report the surgical experience and clinical outcome of THA through a modified miniincision posterolateral surgical approach.Methods Fifteen cases of THA were performed through a modified miniincision posterolateral surgical approach(MIS group).Among them，there were 10 males and 5 females the mean age was 72 years ranging from 65 to 75 years.The average body mass index (BMI) was 23.5 kg/m2 ranging from 20.5 to 26.5 kg/m2.And the mean Harris score was 33.5.For comparison，another 15 cases of THA were performed through a standard posterolateral at the same period (standard group).The mean age，BMI and Harris score were similar to the MIS group.Operation time，blood loss，incision length，functional recovery，and prosthetic positionwere analysed and compared between the above two groups.Results