保留关节囊的前外侧肌间隙入路微创全髋临床疗效分析

摘要

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 .%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。