CAJ | 학술논문

目的：探讨保留关节囊的慕尼黑骨科医院前外侧肌间隙入路（OCM）微创全髋与传统髋关节置换的临床疗效对比。方法2009年1月—2014年1月于该院行髋关节置换术患者106例106髋，其中采取OCM入路微创全髋术53例53髋，传统髋关节置换术53例53髋，分析比较两组患者手术时间、术中出血量、术前术后血红蛋白（ HB ）、红细胞比容（ HCT ）、肌酸激酶（ CK-NAC）、C-反应蛋白（CRP）、手术切口长度、术后前3 d引流量、术后输血量、术后下地时间，术后并发症，术后1个月和1年Harris评分（HHS）及骨性关节炎指数评分（WOMAC），影像学评价，住院时间。结果术后随访7～36个月，平均21．2个月，微创组手术切口长度、手术出血量、术后引流量、术后输血前血红蛋白、术后输血前红细胞比容、术后输血量、术后CK-NAC、CRP、下地活动时间，住院时间明显优于常规组（ P＜0．05）；两组术后影像学评价、术后1个月和1年HHS及WOMAC评分无统计学意义（ P＞0．05）。结论保留关节囊的OCM入路微创全髋置换术相对于传统的全髋置换术有软组织创伤小，术后疼痛小，围手术期出血少，恢复快，术后能早期下床行功能锻等优点。但OCM入路的微创全髋操作相对复杂，应由具有一定临床经验的医生和相应条件的医院开展。
목적：탐토보류관절낭적모니흑골과의원전외측기간극입로（OCM）미창전관여전통관관절치환적림상료효대비。방법2009년1월—2014년1월우해원행관관절치환술환자106례106관，기중채취OCM입로미창전관술53례53관，전통관관절치환술53례53관，분석비교량조환자수술시간、술중출혈량、술전술후혈홍단백（ HB ）、홍세포비용（ HCT ）、기산격매（ CK-NAC）、C-반응단백（CRP）、수술절구장도、술후전3 d인류량、술후수혈량、술후하지시간，술후병발증，술후1개월화1년Harris평분（HHS）급골성관절염지수평분（WOMAC），영상학평개，주원시간。결과술후수방7～36개월，평균21．2개월，미창조수술절구장도、수술출혈량、술후인류량、술후수혈전혈홍단백、술후수혈전홍세포비용、술후수혈량、술후CK-NAC、CRP、하지활동시간，주원시간명현우우상규조（ P＜0．05）；량조술후영상학평개、술후1개월화1년HHS급WOMAC평분무통계학의의（ P＞0．05）。결론보류관절낭적OCM입로미창전관치환술상대우전통적전관치환술유연조직창상소，술후동통소，위수술기출혈소，회복쾌，술후능조기하상행공능단등우점。단OCM입로적미창전관조작상대복잡，응유구유일정림상경험적의생화상응조건적의원개전。
Objective To compare the clinical efficacy between OCM minimally invasive total hip arthroplasty with reserving articular capsule and standard total hip arthroplasty.Methods Selected 106 patients(106hips) from January 2009 to January 2014inour hospi-tal,53cases(53 hips)take OCM minimally invasive total hip arthroplasty with reserving articular capsulesurgeryapproach(OCM group), and other 53 cases(53 hips) underwent traditionalhiparthroplasty surgery(traditional group).The operative time,intraoperative bleeding loss、preoperative and postoperative hemoglobin、hematocrit、CK-NAC,CRP,length of incision,hemoglobin before transfusion、postopera-tive drainage with 3 days , postoperative transfusion、postoperative walking time, postoperativecomplications, postoperativeHarris hip score and WOMAC score after 1 month and 1 year,prosthetic position, hospitalization time were compared and analyzed between the two groups.Results Follow-ups were done for 7 to 36 months(21.2 months on average).OCM group were significantly better thanthe group in blood loss,postoperative drainage within 3 days,postoperative hemoglobin and hematocrit before transfusion,CK-NAC,CRP, postoperative transfusion、incision length,ambulation,hospitalization time(P<0.05).There were no significant differences in postoper-ativeHarris hip score and WOMAC score after 1 month and 1 year,prosthetic position.Conclusions To compared with traditial THA, the adavantages of OCM minimally invasive total hip arthroplasty with reserving articular capsulesurgeryapproach are minor tissue trau-ma,less postoperative pain,less blood lost,fast functional recovery.But the operation is relatively complex,can only be take by surgeons who have rich experience and hospitals which have necessary instruments .