發(fā)布時(shí)間：2018-02-04 01:43

  本文關(guān)鍵詞： 關(guān)節(jié)成形術(shù) 置換 髖 直接前入路 微創(chuàng)外科手術(shù) 后外側(cè)保留梨狀肌入路　出處：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年02期 　論文類型：期刊論文

【摘要】：目的:前瞻性比較直接前入路(direct anterior approach,DAA)和后外側(cè)保留梨狀肌入路(posterolateral piriformis-sparing approach,Mis-PLA)全髖關(guān)節(jié)置換的臨床療效。方法:選自福建省立醫(yī)院骨科2015年3月至2016年2月收入院需行全髖關(guān)節(jié)置換術(shù)的患者,隨機(jī)分為DAA和Mis-PLA兩組。DAA組(43例45髖):男27例27髖,女16例18髖,平均年齡(57.4±7.3)歲,術(shù)前Harris評(píng)分(41.4±8.7)分,體重指數(shù)(body mass index,BMI)為(24.3±2.2)kg/m2;Mis-PLA組(39例42髖):男25例26髖,女14例16髖,平均年齡(59.2±7.3)歲,術(shù)前Harris評(píng)分(39.6±8.4)分,BMI(24.7±2.5)kg/m2。分別對(duì)兩組的切口長(zhǎng)度、手術(shù)時(shí)間、術(shù)中出血量、術(shù)后Harris評(píng)分、關(guān)節(jié)功能恢復(fù)進(jìn)行對(duì)比評(píng)估。結(jié)果:(1)兩組患者手術(shù)切口均Ⅰ/甲級(jí)愈合。手術(shù)切口長(zhǎng)度:DAA組(9.2±0.7)cm,Mis-PLA組(9.5±0.6)cm,兩者間差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.053);手術(shù)時(shí)間:DAA組(74.3±10.1)min,Mis-PLA組(37.5±4.3)min,兩者間差異有統(tǒng)計(jì)學(xué)意義(P0.01);出血量:DAA組(229.6±79.2)m L,Mis-PLA組(215.7±56.0)m L,兩者之間差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.366)。(2)隨訪時(shí)間6~12個(gè)月,術(shù)后6周Harris評(píng)分:DAA組(85.5±4.1)分,Mis-PLA組(79.0±4.4)分,兩組間差異有統(tǒng)計(jì)學(xué)意義(P0.01)。術(shù)后6個(gè)月Harris評(píng)分,DAA組(94.3±2.7)分,Mis-PLA組(95.2±1.9)分,兩組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.125)。術(shù)后6周髖關(guān)節(jié)功能評(píng)估,DAA組和Mis-PLA組在直線步行速度上差異沒(méi)有統(tǒng)計(jì)學(xué)意義(P=0.298),Mis-PLA組上、下樓梯速度優(yōu)于DAA組(P=0.047);在轉(zhuǎn)彎速度、坐下、穿襪時(shí),DAA組優(yōu)于Mis-PLA組(P0.01,P=0.016,P0.01)。結(jié)論:直接前入路和后外側(cè)保留梨狀肌入路的微創(chuàng)全髖關(guān)節(jié)置換術(shù)都能獲得滿意的臨床療效,后外側(cè)入路的優(yōu)勢(shì)在于手術(shù)時(shí)間短、學(xué)習(xí)曲線短,直接前入路的主要優(yōu)勢(shì)在于術(shù)后早期沒(méi)有體位限制的要求及髖關(guān)節(jié)功能恢復(fù)的更快。
[Abstract]:Objective: to prospectively compare direct anterior approach with direct anterior approach. DAA) and posterolateral piriformis-sparing approach reserved for the posterolateral piriformis approach. Clinical effect of Mis-PLA total hip replacement methods: from March 2015 to February 2016, the orthopaedic department of Fujian Provincial Hospital received total hip replacement. DAA and Mis-PLA groups were randomly divided into two groups: 27 males (27 hips) and 16 females (18 hips), with an average age of 57.4 鹵7.3 years. Preoperative Harris score (41.4 鹵8.7) and body mass index (BMI) were 24.3 鹵2.2 kg / m ~ (2); In Mis-PLA group, there were 39 cases (26 hips), 25 males (26 hips) and 14 females (16 hips), with an average age of 59.2 鹵7.3 years. The preoperative Harris score (39.6 鹵8.4) was 24.7 鹵2.5 kg / m2. The incision length, operative time and intraoperative bleeding were measured. The postoperative Harris score and the recovery of joint function were compared and evaluated. Results the operative incision in both groups was 鈪，

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