CAJ | 학술논문

目的探讨前外侧微创全髋关节置换的手术要点及适应证.方法 2004年12月至2005年5月入院进行单侧人工全髋关节置换的110例患者,随机分入传统后外侧人路组和前外侧微创入路组.由同一组医师完成所有手术,分别记录纳入研究患者的一般人口学状况、围手术期测量指标和术后功能随访指标,进行统计分析.结果两组患者基线资料均衡可比.手术时间、术后髋臼外展角、前倾角、前后位片股骨柄假体居中例数和股骨假体3点固定例数等指标差异无统计学意义.前外侧微创入路组手术切口长度为(7.5±0.9)cm、出血量为(376.2±168.3)ml、围手术期输血量为(410.1±136.5)ml、输血人数(36)及术后24 h疼痛评分(30.8±21.8)显著减少(t=28.42、t=6.04、t=6.03、x2=10.45、t=5.64,均P<0.01).术后3个月随访显示前外侧微创人路组患者Harris评分(83.8±5.6)及Barthel指数(93.5±6.4)高于后外侧人路组(t=-7.00、-3.09,均P<0.01),而术后3年随访结果差异无统计学意义.结论前外侧微创全髋关节置换手术在不影响假体稳定性的前提下能够减轻手术创伤、减少出血、促进机体康复.此种术式需要特殊设备,对手术医师有较高要求.
목적 탐토전외측미창전관관절치환적수술요점급괄응증.방법 2004년12월지2005년5월입원진행단측인공전관관절치환적110례환자,수궤분입전통후외측인로조화전외측미창입로조.유동일조의사완성소유수술,분별기록납입연구환자적일반인구학상황、위수술기측량지표화술후공능수방지표,진행통계분석.결과 량조환자기선자료균형가비.수술시간、술후관구외전각、전경각、전후위편고골병가체거중례수화고골가체3점고정례수등지표차이무통계학의의.전외측미창입로조수술절구장도위(7.5±0.9)cm、출혈량위(376.2±168.3)ml、위수술기수혈량위(410.1±136.5)ml、수혈인수(36)급술후24 h동통평분(30.8±21.8)현저감소(t=28.42、t=6.04、t=6.03、x2=10.45、t=5.64,균P<0.01).술후3개월수방현시전외측미창인로조환자Harris평분(83.8±5.6)급Barthel지수(93.5±6.4)고우후외측인로조(t=-7.00、-3.09,균P<0.01),이술후3년수방결과 차이무통계학의의.결론 전외측미창전관관절치환수술재불영향가체은정성적전제하능구감경수술창상、감소출혈、촉진궤체강복.차충술식수요특수설비,대수술의사유교고요구.
Objective To explore the indications and key points of anterolateral minimally-invasive total hip arthroplasty. Methods 110 baseline indexes matched patients admitted for unilateral total hip arthroplasty were randomly assigned to 2 equal groups to undergo surgery through a short anterolateral incision of ≤ 10 em or a standard posterolateral incision. All operations were done by the same surgeon. The demographic data, perioperative indexes, and postoperative function indexes were recorded and statistically analyzed. Results No significant differences were detected with respect to operation time, abduction angle, anteversion angle, stem alignment, and stem fixation between these 2 groups. The incision length, blood loss, perioperative transfusion, and 100 -mm visual analogue pain scale (VAS) score at the first 24 hours of the anterolateral approach group were (7.49±0.86) cm, (376.18±168.30) ml, (410.09 ± 136.46) ml, and (30.76±21.77) respectively, all significantly shorter, less, or lower than those of the standard posterolateral approach group [(15.2±1.8) cm, (605.0±225.1) ml, (629.5±232.9) nd, and (50.3 ±13.7) respectively, all P <0.01]. The Harris hip score and Barthel index 3 months after operation of the anterolateral approach group were (83.80± 5.64) and (93.45±6.37) respectively, both significantly higher than those of the standard pesterolateral approach group [(75.0±7.5) and (94.6±7.5) respectively, both P <0.01)], however, there were not significant differences in the Harris hip score and Barthel index 3 years after operation between these 2 groups. Conclusions Fewer traumas, less blood loss and rapid recovery can be obtained through this new total hip arthoplasty approach. But experienced doctors and special instruments are prerequisite.