CAJ | 학술논문

目的探讨对于无选择患者微创全髋关节置换(total hip arthroplasty,THA)后侧入路缩短切口长度的合理性,并比较不同切口长度患者的临床效果.方法对2001年3月-2007年12月共256例单侧THA患者进行前瞻性研究.术前均不特意选择切口长度,采用后侧入路及微创手术技术,按照术后切口长度测量值分组:小切口组(＜10 cm)99例,中度切口组(10～14 cm)112例,标准切口组(＞14 cm)45例.收集住院期间患者相关资料包括年龄、性别、诊断、体重指数(body mass index,BMI)、手术时间、术中出血量和总出血量、外旋肌保留和关节囊修复情况,分析术后X线平片,记录术中及术后并发症.术前及术后采用视觉模拟疼痛评分法(visual analog scale,VAS)来估测疼痛强度,Harris评分评定患髋功能.结果所有患者均获随访,平均随访时间6.1年(2.5～9.2年).有211例无选择THA患者可用较小的切口(＜14 cm)完成手术.小切口组体重指数低,术中出血量少,术后早期疼痛轻、对切口满意度高,但其髋臼假体外展角异常比例更高,与其余两组比较差异有统计学意义(P＜0.05).中度切口组在关节囊解剖位修复及梨状肌保留例数、手术时间和术后6周Harris评分与小切口组相同,但与标准切口组比较差异有统计学意义(P＜0.05).结论对于无选择THA患者采用微创手术技术,较小的后侧切口可以获得安全满意的疗效.尽量缩短手术切口而非强求小切口,可最大限度减轻软组织损伤使手术顺利进行,并保证远期临床效果.
목적 탐토대우무선택환자미창전관관절치환(total hip arthroplasty,THA)후측입로축단절구장도적합이성,병비교불동절구장도환자적림상효과.방법대2001년3월-2007년12월공256례단측THA환자진행전첨성연구.술전균불특의선택절구장도,채용후측입로급미창수술기술,안조술후절구장도측량치분조:소절구조(＜10 cm)99례,중도절구조(10～14 cm)112례,표준절구조(＞14 cm)45례.수집주원기간환자상관자료포괄년령、성별、진단、체중지수(body mass index,BMI)、수술시간、술중출혈량화총출혈량、외선기보류화관절낭수복정황,분석술후X선평편,기록술중급술후병발증.술전급술후채용시각모의동통평분법(visual analog scale,VAS)래고측동통강도,Harris평분평정환관공능.결과소유환자균획수방,평균수방시간6.1년(2.5～9.2년).유211례무선택THA환자가용교소적절구(＜14 cm)완성수술.소절구조체중지수저,술중출혈량소,술후조기동통경、대절구만의도고,단기관구가체외전각이상비례경고,여기여량조비교차이유통계학의의(P＜0.05).중도절구조재관절낭해부위수복급리상기보류례수、수술시간화술후6주Harris평분여소절구조상동,단여표준절구조비교차이유통계학의의(P＜0.05).결론대우무선택THA환자채용미창수술기술,교소적후측절구가이획득안전만의적료효.진량축단수술절구이비강구소절구,가최대한도감경연조직손상사수술순리진행,병보증원기림상효과.
Objective To explore the reasonability of posterior approach incision length in an unselected patient cohort with minimally invasive total hip arthroplasty (THA) and compare the clinical results of different incision lengths. Methods A consecutive unselected 256 patients who underwent primary unilateral THA between March 2001 and December 2007 were studied prospectively. Prior to the operation, the incision length was not deliberately selected for the patients. A posterior approach was used for all procedures with minimally invasive surgical techniques. The patients were divided into three groups according to the incision length at the end of surgery: mini-incision group ( ＜ 10 cm, 99 patients) , moderate incision group (10-14 cm, 112 patients) and standard incision group ( ＞ 14 cm, 45 patients). The in-hospital data including age, sex, diagnosis,body mass index (BMI),operation duration, intraoperative blood loss, total blood loss, preservation of the external rotators, anatomic repair of the capsule as well as postoperative radiographs were collected for analysis of the intraoperative and postoperative complications. The pain was estimated by using the individual visual analog scale (VAS) and the functional outcome evaluated by Harris hip score preoperatively and postoperatively. Results All the patients were followed up for an average period of 6.1 years (2.5-9.2 years). The incision length was shortened and optimized ( ＜ 14 cm) in 211 patients. There showed decrease of BMI, less intraoperative blood loss, less pain, satisfactory outcome but higher proportion of abnormal abduction angle of the acetabular prosthesis in the early postoperative period in the mini-incision group, with statistical difference compared with the other two groups (P ＜ 0.05). The preservation of the piriformis tendon, anatomic repair of the joint capsule, operation duration and Harris score at 6th postoperative week in the moderate incision group were similar to those in the mini incision group but showed statistical difference in comparison with the standard incision group ( P ＜0. 05). Conclusions Minimally invasive THA with a smaller posterior incision can attain safe and effective curative effect for the unselected patient cohort. A smaller but not necessarily miniincision may allow minimal soft tissue trauma for the surgeon to perform the procedure well and ensure a long-term clinical results.