微创前外侧肌间隙入路联合股骨颈保留在全髋关节置换术中的应用效果

doi:10.3760/cma.j.issn.1007-1245.2024.18.005

摘要/Abstract

摘要：

目的　评估微创前外侧肌间隙入路联合股骨颈保留在全髋关节置换术中的应用效果。方法　回顾性分析2019年1月至2022年1月在渭南市第二医院接受全髋关节置换术的83例患者临床资料，其中42例采用微创前外侧肌间隙入路全髋关节置换术，并保留股骨颈，设为观察组；41例采用传统后外侧入路全髋关节置换术，设为对照组。观察组中男20例，女22例，年龄（63.75±6.76）岁；对照组中男23例，女18例，年龄（63.49±6.57）岁。比较两组患者的围手术期指标，术前和术后1 d的血清肌酸磷酸激酶（CPK）水平，术前和术后12个月的视觉模拟评分法（VAS）评分、髋关节Harris评分、Berg平衡量表（BBS）评分、步态参数、两侧肢体长度差、髋臼旋转中心的纵向及横向位移。采用t检验、χ²检验。结果　观察组患者的手术时间、术中出血量、切口长度、术后1 d引流量、术后1 d CPK水平分别为（60.26±7.41）min、（210.45±33.94）ml、（7.71±1.96）cm、（82.35±8.48）ml、（384.75±29.76）U/L，对照组分别为（68.97±8.35）min、（328.15±42.06）ml、（11.27±2.43）cm、（117.89±12.12）ml、（668.40±45.94）U/L，差异均有统计学意义（t=5.029、14.047、7.355、15.510、33.299，均P<0.001）。术后12个月，观察组的VAS评分、髋关节Harris评分、BBS评分、步频、最大步速、单足支撑时间百分比、足底压力差分别为（0.67±0.21）分、（90.45±9.37）分、（52.71±3.14）分、（96.79±8.12）步/min、（89.94±10.63）cm/s、（46.59±5.31）%、（9.02±1.03）%，对照组分别为（0.89±0.27）分、（82.63±8.04）分、（45.42±4.83）分、（81.14±7.59）步/min、（80.21±9.87）cm/s、（40.87±5.16）%、（10.61±2.12）%，差异均有统计学意义（t=4.137、4.084、8.131、9.074、4.323、4.977、4.329，均P<0.001）。影像学检查结果显示，观察组患者术后12个月的双侧肢体长差、纵向与横向的髋臼旋转中心位移均低于对照组（t=5.473、7.707、10.698，均P<0.001）。结论　微创前外侧肌间隙入路联合股骨颈保留有助于全髋关节置换术后恢复，改善患者髋关节功能。

关键词:

髋关节, 全髋关节置换术, 微创, 前外侧肌间隙入路, 股骨颈保留, 髋关节功能, 术后恢复

Abstract:

Objective　To evaluate the application effect of anterolateral intermuscular approach combined with femoral neck preservation in total hip arthroplasty. Methods　The clinical data of 83 patients who underwent total hip arthroplasty in the Second Hospital of Weinan from January 2019 to January 2022 were retrospectively analyzed. Among them, 42 patients underwent minimally invasive total hip arthroplasty via anterolateral intermuscular approach, with femoral neck preservation, who were set as an observation group; 41 patients who underwent total hip arthroplasty via conventional posterolateral approach were set as a control group. In the observation group, there were 20 males and 22 females, aged (63.75±6.76) years. In the control group, there were 23 males and 18 females, aged (63.49±6.57) years. The perioperative indicators, serum creatine phosphokinase (CPK) levels before and 1 d after surgery, as well as Visual Analogue Scale (VAS) scores, Harris hip scores, Berg Balance Scale (BBS) scores, gait parameters, differences in bilateral limb length, and vertical and horizontal displacement of the hip center of rotation (HCOR) before and 12 months after surgery were compared between the two groups. t test and χ² test were used. Results　The operation time, intraoperative blood loss, incision length, drainage volume 1 d after surgery, and CPK level 1 d after surgery in the observation group were (60.26±7.41) min, (210.45±33.94) ml, (7.71±1.96) cm, (82.35±8.48) ml, and (384.75±29.76) U/L, and those in the control group were (68.97±8.35) min, (328.15±42.06) ml, (11.27±2.43) cm, (117.89±12.12) ml, and (668.40±45.94) U/L, with statistically significant differences (t=5.029, 14.047, 7.355, 15.510, and 33.299, all P<0.001). Twelve months after surgery, the VAS score, hip Harris score, BBS score, stride frequency, maximum step speed, percentage of single-leg support time, and plantar pressure difference in the observation group were (0.67±0.21) points, (90.45±9.37) points, (52.71±3.14) points, (96.79±8.12) steps/min, (89.94±10.63) cm/s, (46.59±5.31)%, and (9.02±1.03)%, and those in the control group were (0.89±0.27) points, (82.63±8.04) points, (45.42±4.83) points, (81.14±7.59) steps/min, (80.21±9.87) cm/s, (40.87±5.16)%, and (10.61±2.12) %, with statistically significant differences (t=4.137, 4.084, 8.131, 9.074, 4.323, 4.977, and 4.329, all P<0.001). Imaging results showed that the difference in bilateral limb length and vertical and horizontal displacement of the HCOR in the observation group were lower than those in the control group 12 months after surgery (t=5.473, 7.707, and 10.698, all P<0.001). Conclusion　Anterolateral intermuscular approach combined with femoral neck preservation appears to enhance postoperative recovery and improve hip joint function in patients undergoing total hip arthroplasty.

Key words:

Hip , joint, Total hip arthroplasty, Anterolateral intermuscular approach, Femoral neck preservation, Hip joint function, , Postoperative recovery

王林鹰高练兵周佳毅.

微创前外侧肌间隙入路联合股骨颈保留在全髋关节置换术中的应用效果 [J]. 国际医药卫生导报, 2024, 30(18): 3012-3017.

Wang Linying, Gao Lianbing, Zhou Jiayi.

Application of anterolateral intermuscular approach combined with femoral neck preservation in total hip arthroplasty [J]. International Medicine and Health Guidance News, 2024, 30(18): 3012-3017.

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