SuperPATH与后外侧入路全髋关节置换术临床疗效比较Comparison of clinical outcomes of superPATH approach versus posterolateral approach for total hip replacement
吴长坤;姜任东;杨波;姜鑫;王兆泉;
摘要(Abstract):
[目的]比较Super PATH微创与常规后外侧入路全髋关节置换术(total hip arthroplasty,THA)的近期临床疗效。[方法]选取2015年8月~2017年5月在潍坊市人民医院关节外科符合标准并接受单侧THA的患者40例作为研究对象,其中20例实施Super PATH微创THA(微创组),20例实施常规后外侧入路THA(常规组)。比较两组患者的切口长度、手术时间、术中出血量、手术前后血红蛋白差值、手术前后疼痛VAS评分及Harris评分、术后并发症(关节脱位、假体周围骨折、下肢深静脉血栓形成、假体周围感染)及术后首次下地时间。[结果]40例患者均顺利完成手术,无血管神经损伤等严重并发症。微创组在切口长度[(7.14±0.33)cm vs(11.75±0.18)cm,P<0.05],术中出血量[(130.00±10.88)ml vs(236.25±13.27)ml,P<0.05],手术前后血红蛋白差值[(26.05±3.19)g/L vs(34.75±2.45)g/L,P<0.05]及术后首次下地时间[(7.90±1.25)h vs(28.10±1.25)h,P<0.05]方面均优于常规组,差异有统计学意义。此外,微创组在术后24h疼痛VAS评分[(2.05±0.76)vs(3.95±0.69),P<0.05]及术后2周髋关节Harris评分[(74.65±1.93)vs(64.85±1.46),P<0.05]优于常规组,差异有统计学意义。但术后半年,两组间在VAS和Harris评分的差异均无统计学意义(P<0.05)。两组患者术后均未发生关节脱位、假体周围骨折、下肢静脉血栓形成及假体周围感染等并发症。[结论]Super PATH微创与常规后外侧入路全髋关节置换术相比,具有切口小、围手术期出血少、术后疼痛轻、术后恢复快等优势,但其远期疗效仍有待进一步观察。
关键词(KeyWords): 全髋关节置换术(THA);SuperPATH入路;后外侧入路
基金项目(Foundation):
作者(Author): 吴长坤;姜任东;杨波;姜鑫;王兆泉;
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参考文献(References):
- [1]Xie J,Zhang H,Wang L,et al.Comparison of supercapsular percutaneously assisted approach total hip versus conventional posterior approach for total hip arthroplasty:a prospective,randomized controlled trial[J].Orthop Surg Res.2017,12(1):138.
- [2]曾昭池,郭中凯,朱志勇,等.微创与常规全髋关节置换术的临床疗效比较[J].中国矫形外科杂志,2013,21(12):1173-1176.
- [3]Chow J,Penenberg B,Murphy S.Modified micro-superior percutaneously-assisted total hip:early experiences&case reports[J].Curr Rev Musculoskelet Med,2011,4(3):146-150.
- [4]Glassou EN,Pedersen AB,Hansen TB.Risk of re-admission,reoperation,and mortality within 90 days of total hip and knee arthroplasty in fast-track departments in Denmark from 2005 to 2011[J].Acta Orthop,2014,85(5):493-500.
- [5]王建然,林祥波,王静,等.微创人工全髋关节置换术的临床研究[J].中国矫形外科杂志,2012,20(18):1673-1676.
- [6]Michael DC,Wade G,Lindsey E,et al.Early surgical and functional outcomes comparison of the supercapsular percutaneously-assisted total hip and traditional posterior surgical techniques for total hip arthroplasty:protocol for a randomized,controlled study[J].Ann Transl Med,2015,3(21):335.
- [7]Gofton W,Chow J,Olsen KD,et al.Thirty-day readmission rate and discharge status following total hip arthroplasty using the supercapsular percutaneously-assisted total hip surgical technique[J].Int Orthop,2015,39(5):847-851.
- [8]Rasuli KJ,Gofton W.Percutaneously assisted total hip(PATH)and Supercapsular percutaneously assisted total hip(Super PATH)arthroplasty:learning curves and early outcomes[J].Ann Transl Med,2015,3(13):179.
- [9]Itokawa T,Nakashima Y,Yamamoto T,et al.Late dislocation is associated with recurrence aft er total hip arthroplasty[J].Int Orthop,2013,37(8):1457-1463.
- [10]Capuano N,Del Buono A,Maffulli N.Tissue preserving total hip arthroplasty using superior capsulotomy[J].Oper Orthop Traumatol,2015,27(4):334-341.
- [11]Cardenas-Nylander C,Bellotti V,Astarita E,et al.Innovative approach in total hip arthroplasty:supercapsular percutaneously assisted[J].Hip Int,2016,26 Suppl(1):34-37.
- [12]Wade G,David AF.In-hospital cost comparison between the standard lateral and supercapsular percutaneously-assisted total hip surgical techniques for total hip replacement[J].International Orthopaedics(SICOT),2015,40(3):481-5.
- [13]Arora KS,Khan N,Abboudi H,et al.Learning curves for cardiothoracic and vascular surgical procedures-a systematic review[J].Postgrad Med,2015,127(2):202-14.
- [14]Yeolekar A.The learning curve in surgical practice and its applicability to rhinoplasty[J].Indian J Otolaryngol Head Neck Surg,2018,70(1):38-42.
- [15]Hailer NP,Weiss RJ,Stark A,et al.The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach,femoral head size,sex,and primary diagnosis.An analysis of 78,098 operations in the Swedish Hip Arthroplasty Register[J].Acta Orthop,2012,83(5):442-448.