两种微创入路全髋关节置换术比较

Comparison of two minimally invasive approaches for total hip arthroplasty

摘要:

［目的］ 比较慕尼黑骨科医院 （Orthopadische Chirurgie Munchen, OCM） 入路和直接外侧入路 （direct lateral approach, DLA）全髋关节置换术中的临床疗效。［方法］回顾性分析本院骨科 2018 年 1 月—2022 年 1 月全髋关节置换手术病例 53 例患者的临床资料，根据术前医患沟通结果，18 例采取 OCM 入路，35 例采取 DLA 入路。比较两组围手术期、随访及影像资料。 ［结果］两组均顺利完成手术，无神经、血管损伤等严重并发症发生。OCM 手术时间显著长于 DLA 组（P<0.05），但是，OCM 组切口长度、术中出血量、输血率、术后下床时间及住院时间均显著优于 DLA 组（P<0.05）。随访时间平均（15.0±3.2）个月，术后随时间推移，两组患者 Harris 评分、髋伸屈 ROM 均显著增加（P<0.05）。术前两组间 Harris 评分、髋伸屈 ROM 的差异均无统计学意义（P>0.05），术后 1 个月，OCM 组 Harris 评分、髋伸屈 ROM 均显著优于 DLA 组（P>0.05），但术后 3 个月及末次随访两组上述指标的差异无统计学意义（P>0.05）。影像方面，术后两组患者髋臼外展角、前倾角及双侧下肢长度差值的差异均无统计学意义（P>0.05）。［结论］ 全髋关节置换术 OCM 入路手术时间较传统前外侧入路长，但是具有损伤小，出血量少，及术后恢复快等优点。

Abstract:

[Objective] To compare the clinical outcomes of total hip arthroplasty (THA) through the Orthopadische Chirurgie Munchen (OCM) approach versus the direct lateral approach (DLA). [Methods] A retrospective study was performed on 53 patients who received THA in our hospital from January 2018 to January 2022. According to the results of preoperative doctor-patient communication, 18 patients had THA performed through OCM approach,while the other 35 patients took DLA approach. The perioperative period, follow-up and imaging da- ta were compared between the two groups. [Results] All patients in both groups had THA completed successfully without nerve or vascular injury and other serious complications. Although the OCM group spend significantly longer operation time than the DLA group (P＜0.05), the former proved significantly superior to the latter in terms of incision length, intraoperative blood loss, blood transfusion rate, postoperative time of getting out of bed and hospital stay (P＜0.05). As time went during follow-up lasted for (15.0±3.2) months on an average, the Harris score and hip extension-flexion range of motion (ROM) significantly increased in both groups (P＜0.05). There were no significant differences in preoperative Harris score and ROM between the two groups (P＞0.05), which in the OCM group were significantly superior to those in the DLA group one month after surgery (P＜0.05), whereas became not statistically significant between the two groups 3 months after surgery and at the latest follow-up (P＞0.05). Radiographically, the acetabular abduction angle, anteversion angle and bilateral leg length discrepancy were not statistically significant between the two groups postoperatively (P＞0.05). [Conclusion] Compared with the traditional DLA, the OCM approach used in THA has the advantages of less injury, less bleeding and faster postoperative recovery.