比基尼入路和前外侧小切口入路全髋关节置换术的临床效果比较研究
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摘要
目的通过对比比基尼(Bikini)入路和前外侧小切口(OCM)入路首次全髋关节置换术的近期临床效果,对两种手术入路进行分析评价。方法回顾性选取2016年9月至2017年9月于青岛大学附属医院关节外科首次行全髋关节置换80例(80髋)诊断为股骨头缺血性坏死患者,排除诊断为类风湿性关节炎、先天性髋关节发育不良或脱位和既往髋关节手术史患者。其中行经Bikini切口的前入路40例,OCM入路40例。男性47例,女性33例,平均年龄(66±10)岁。通过独立样本t检验分析两组患者一般资料、手术时间、术中出血量、术后引流量、血红蛋白含量的变化、术后输血率、切口长度、肢体不等长发生率、住院天数、围手术期Harris评分和视觉模拟疼痛(VAS)评分、股四头肌和髋关节外展肌肌力恢复时间、血清股酸激酶(CK)、C反应蛋白(CRP)的变化量、影像学表现及手术并发症,评价两种手术方式的围手术期效果。结果 80例患者平均随访(6. 5±2. 3)个月。与OCM组相比,Bikini组患者的髋关节外展肌肌力恢复时间略短,术后血清CK、CRP变化量少。而在患者一般资料、手术时间、术中失血量、术后引流量、血红蛋白含量的变化、术后输血率、手术切口长度、肢体不等长发生率、住院时间、围手术期Harris评分和VAS评分、股四头肌肌力恢复时间及影像学表现方面两组无明显差异。但是Bikini组和OCM组在手术时间、术中出血量、术后引流量、髋臼前倾角和外展角方面均出现了前10例患者与后30例患者相比差异具有统计学意义(均为P <0. 01)。结论 Bikini入路与OCM入路均能取得良好的短期临床效果,Bikini入路对肌肉损伤小,炎症反应弱,外展肌肌力恢复快。两种手术入路均存在学习曲线。
Objective To evaluate and compare the early clinical results between bikini incision for anterior approach and orthop?dische chirurgie München( OCM) approach for total hip arthropasty. Methods Eighty patients( 80 hips) with avascular necrosis of the femoral head who underwent total hip arthroplasty for the first time from September 2016 to September 2017 in the Joint Surgery Department of the Affiliated Hospital of Qingdao University were retrospectively selected. Patients diagnosed as rheumatoid arthritis,congenital dysplasia or dislocation of the hip and previous history of hip surgery were excluded. Among them,30 coses underwent Bikini incision for direct anterior approech( DAA) and 30 cases underwent OCM. There were 47 males and 33 females with an average age of( 66 ± 10) years. The general data,operation time,intraoperative bleeding volume,postoperative drainage volume,hemoglobin content,postoperative blood transfusion rate,incision length,limb unequal length incidence,hospitalization days,perioperative Harris score and visual analogue scale( VAS) score,quadriceps femoris and abductor hip muscle strength recovery time,amount of CK and CRP in serum,imaging findings and surgical complications were analyzed to evaluate the perioperative effects of the two surgical methods. Results A total of 80 patients were followed up for an average of( 6. 5 ± 2. 3) months. Compared with OCM group,Bikini group had shorter recovery time of abductor muscle strength and less changes of serum CK and CRP. However,there was no significant difference in general information,operative time,intraoperative blood loss,postoperative drainage,hemoglobin content,postoperative blood transfusion rate,incision length,limb unequal length,hospitalization time,perioperative Harris score,VAS,quadriceps femoris muscle strength recovery time or imaging findings between the two groups. But Bikini approach and OCM approach had significant differences in operative time,intraoperative bleeding volume,postoperative drainage,acetabular anteversion and abduction angle between the first 10 patients and the latter 30 patients( all P < 0. 01). Conclusions Bikini approach and OCM approach can achieve good short-term clinical results. Bikini approach has less muscle damage, weak inflammatory response,abductor muscle strength recovery is fast. There is a learning curve in the two operative approaches.
Objective To evaluate and compare the early clinical results between bikini incision for anterior approach and orthop?dische chirurgie München( OCM) approach for total hip arthropasty. Methods Eighty patients( 80 hips) with avascular necrosis of the femoral head who underwent total hip arthroplasty for the first time from September 2016 to September 2017 in the Joint Surgery Department of the Affiliated Hospital of Qingdao University were retrospectively selected. Patients diagnosed as rheumatoid arthritis,congenital dysplasia or dislocation of the hip and previous history of hip surgery were excluded. Among them,30 coses underwent Bikini incision for direct anterior approech( DAA) and 30 cases underwent OCM. There were 47 males and 33 females with an average age of( 66 ± 10) years. The general data,operation time,intraoperative bleeding volume,postoperative drainage volume,hemoglobin content,postoperative blood transfusion rate,incision length,limb unequal length incidence,hospitalization days,perioperative Harris score and visual analogue scale( VAS) score,quadriceps femoris and abductor hip muscle strength recovery time,amount of CK and CRP in serum,imaging findings and surgical complications were analyzed to evaluate the perioperative effects of the two surgical methods. Results A total of 80 patients were followed up for an average of( 6. 5 ± 2. 3) months. Compared with OCM group,Bikini group had shorter recovery time of abductor muscle strength and less changes of serum CK and CRP. However,there was no significant difference in general information,operative time,intraoperative blood loss,postoperative drainage,hemoglobin content,postoperative blood transfusion rate,incision length,limb unequal length,hospitalization time,perioperative Harris score,VAS,quadriceps femoris muscle strength recovery time or imaging findings between the two groups. But Bikini approach and OCM approach had significant differences in operative time,intraoperative bleeding volume,postoperative drainage,acetabular anteversion and abduction angle between the first 10 patients and the latter 30 patients( all P < 0. 01). Conclusions Bikini approach and OCM approach can achieve good short-term clinical results. Bikini approach has less muscle damage, weak inflammatory response,abductor muscle strength recovery is fast. There is a learning curve in the two operative approaches.
引文
[1]陈朦村,杨述华,叶树楠,等.直接前路与微创后外侧入路初次全髋关节置换术早期临床疗效比较[J/CD].中华关节外科杂志(电子版),2017,11(4):344-351.
[2]Meermans G,Konan S,Das R,et al.The direct anterior approach in total hip arthroplasty:a systematic review of the literature[J].Bone Joint J,2017,99B(6):732-740.
[3]Sculco TP,Jordan LC,Walter WL.Minimally invasive total hip arthroplasty:the Hospital for Special Surgery experience[J].Orthop Clin North Am,2004,35(2):137-142.
[4]Post ZD,Orozco F,Diaz-Ledezma C,et al.Direct anterior approach for total hip arthroplasty:indications,technique,and results[J].J Am Acad Orthop Surg,2014,22(9):595-603.
[5]王荣,李秀霞,高明暄,等.微创与传统全髋关节置换术临床疗效对比的系统评价[J].中国骨伤,2016,29(2):172-178.
[6]Yue C,Kang PD,Pei FX.Comparison of direct anterior and lateral approaches in total hip arthroplasty a systematic review and meta-analysis(PRISMA)[J/OL].Medicine(Baltimore),2015,94(50):e2126.doi:10.1097/MD.0000000000002126.
[7]Moerenhout KG,Cherix S,Rüdiger HA.Total hip arthroplasty through anterior“minimal invasive”approach[J].Rev Med Suisse,2012,8(367):2429-2432.
[8]Learmonth ID,Young C,Rorabeck C.The operation of the century:total hip replacement[J].Lancet,2007,370(9597):1508-1519.
[9]Jung J,Anagnostakos K,Kohn D.Clinical results of minimally invasive total hip arthroplasty[J].Orthopade,2012,41(5):399-406.
[10]Roettinger H.Minimally invasive anterolateral surgical approach for total hip arthroplasty:Early clinical results[J].Hip Int,2006,16(2,4):S42-S47.
[11]R9ttinger H.Minimally invasive anterolateral approach for total hip replacement(OCM technique)[J].Oper Orthop Traumatol,2010,22(4):421-430.
[12]Martin R,Clayson PE,Troussel S,et al.Anterolateral minimally invasive total hip arthroplasty:a prospective randomized controlled study with a follow-up of 1 year[J].J Arthroplasty,2011,26(8):1362-1372.
[13]Keith,P,Connolly,et al.Direct anterior total hip arthroplasty:literature review of variations in surgical technique[J].World JOrthop,2016,7(1):38-43.
[14]Connolly KP,Kamath AF.Direct anterior total hip arthroplasty:comparative outcomes and contemporary results[J].World JOrthop,2016,7(2):94-101.
[15]Faldini C,Mazzotti A,Perna F,et al.Modified minimally invasive direct anterior approach through a bikini incision for total hip arthroplasty:technique and results in young female patients[J].J Biol Regul Homeost Agents,2017,31(4 suppl 1):83-89.
[16]Leunig M,Faas M,Von Knoch F,et al.Skin crease‘bikini’incision for anterior approach total hip arthroplasty:surgical technique and preliminary results[J].Clin Orthop Relat Res,2013,471(7):2245-2252.
[17]Leunig M,Hutmacher JE,Ricciardi BF,et al.Skin crease‘bikini’incision for the direct anterior approach in total hip arthroplasty[J].Bone Joint J,2018,100B(7):853-861.
[18]Putananon C,Tuchinda H,Arirachakaran A,et al.Comparison of direct anterior,lateral,posterior and posterior-2 approaches in total hip arthroplasty:network meta-analysis[J].Eur J Orthop Surg Traumatol,2018,28(2):255-267.
[19]Reichert JC,Volkmann MR,Koppmair M,et al.Comparative retrospective study of the direct anterior and transgluteal approaches for primary total hip arthroplasty[J].Int Orthop,2015,39(12):2309-2313.
[20]Landgraeber S,Quitmann H,Güth S,et al.A prospective randomized peri-and post-operative comparison of the minimally invasive anterolateral approach versus the lateral approach[J/OL].Orthop Rev(Pavia),2013,5(3):e19.doi:10.4081/or.2013.e19.
[21]Van Oldenrijk J,Hoogland PV,Tuijthof GJ,et al.Soft tissue damage after minimally invasive THA[J].Acta Orthop,2010,81(6):696-702.
[22]Apple FS,Rhodes M.Enzymatic estimation of skeletal muscle damage by analysis of changes in serum creatine kinase[J].J Appl Physiol,1988,65(6):2598-2600.
[23]Byrnes WC,Clarkson PM,White JS,et al.Delayed onset muscle soreness following repeated bouts of downhill running[J].J Appl Physiol,1985,59(3):710-715.
[24]Teet JS,Skinner HB,Khoury L.The effect of the“mini”incision in total hip arthroplasty on component position[J].J Arthroplasty,2006,21(4):503-507.doi:10.1016/j.arth.2005.06.011.
[25]D’lima DD,Urquhart AG,Buehler KO,et al.The effect of the orientation of the acetabular and femoral components on the range of motion of the hip at different head-neck ratios[J].J Bone Joint Surg Am,2000,82(3):315-321.
[26]古明晖,张志奇,何爱珊,等.骨盆倾斜角和骶骨倾斜角在合并脊柱疾病的患者行初次全髋关节置换术中的作用[J/CD].中华关节外科杂志(电子版),2013,7(2):134-137.
[27]Archibeck MJ,White RE.Learning curve for the two-incision total hip replacement[J].Clin Orthop Relat Res,2004,(429):232-238.
[28]Den Hartog YM,Mathijssen NM,Vehmeijer SB.The less invasive anterior approach for total hip arthroplasty:a comparison to other approaches and an evaluation of the learning curve-a systematic review[J].Hip Int,2016,26(2):105-120.
[29]Müeller DA,Zingg PO,Dora C.Anterior minimally invasive approach for total hip replacement:five-year survivorship and learning curve[J].Hip Int,2014,24(3):277-283.
[30]De Geest T,Fennema P,Lenaerts G,et al.Adverse effects associated with the direct anterior approach for total hip arthroplasty:a Bayesian meta-analysis[J].Arch Orthop Trauma Surg,2015,135(8):1183-1192.
[31]Spaans AJ,van den Hout JA,Bolder SB.High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach[J].Acta Orthop,2012,83(4):342-346.
[32]张先龙,沈灏,王琦,等.前外侧肌间隙入路微创全髋关节置换术的应用解剖与临床研究[J].中华骨科杂志,2007,27(4):268-272.
[2]Meermans G,Konan S,Das R,et al.The direct anterior approach in total hip arthroplasty:a systematic review of the literature[J].Bone Joint J,2017,99B(6):732-740.
[3]Sculco TP,Jordan LC,Walter WL.Minimally invasive total hip arthroplasty:the Hospital for Special Surgery experience[J].Orthop Clin North Am,2004,35(2):137-142.
[4]Post ZD,Orozco F,Diaz-Ledezma C,et al.Direct anterior approach for total hip arthroplasty:indications,technique,and results[J].J Am Acad Orthop Surg,2014,22(9):595-603.
[5]王荣,李秀霞,高明暄,等.微创与传统全髋关节置换术临床疗效对比的系统评价[J].中国骨伤,2016,29(2):172-178.
[6]Yue C,Kang PD,Pei FX.Comparison of direct anterior and lateral approaches in total hip arthroplasty a systematic review and meta-analysis(PRISMA)[J/OL].Medicine(Baltimore),2015,94(50):e2126.doi:10.1097/MD.0000000000002126.
[7]Moerenhout KG,Cherix S,Rüdiger HA.Total hip arthroplasty through anterior“minimal invasive”approach[J].Rev Med Suisse,2012,8(367):2429-2432.
[8]Learmonth ID,Young C,Rorabeck C.The operation of the century:total hip replacement[J].Lancet,2007,370(9597):1508-1519.
[9]Jung J,Anagnostakos K,Kohn D.Clinical results of minimally invasive total hip arthroplasty[J].Orthopade,2012,41(5):399-406.
[10]Roettinger H.Minimally invasive anterolateral surgical approach for total hip arthroplasty:Early clinical results[J].Hip Int,2006,16(2,4):S42-S47.
[11]R9ttinger H.Minimally invasive anterolateral approach for total hip replacement(OCM technique)[J].Oper Orthop Traumatol,2010,22(4):421-430.
[12]Martin R,Clayson PE,Troussel S,et al.Anterolateral minimally invasive total hip arthroplasty:a prospective randomized controlled study with a follow-up of 1 year[J].J Arthroplasty,2011,26(8):1362-1372.
[13]Keith,P,Connolly,et al.Direct anterior total hip arthroplasty:literature review of variations in surgical technique[J].World JOrthop,2016,7(1):38-43.
[14]Connolly KP,Kamath AF.Direct anterior total hip arthroplasty:comparative outcomes and contemporary results[J].World JOrthop,2016,7(2):94-101.
[15]Faldini C,Mazzotti A,Perna F,et al.Modified minimally invasive direct anterior approach through a bikini incision for total hip arthroplasty:technique and results in young female patients[J].J Biol Regul Homeost Agents,2017,31(4 suppl 1):83-89.
[16]Leunig M,Faas M,Von Knoch F,et al.Skin crease‘bikini’incision for anterior approach total hip arthroplasty:surgical technique and preliminary results[J].Clin Orthop Relat Res,2013,471(7):2245-2252.
[17]Leunig M,Hutmacher JE,Ricciardi BF,et al.Skin crease‘bikini’incision for the direct anterior approach in total hip arthroplasty[J].Bone Joint J,2018,100B(7):853-861.
[18]Putananon C,Tuchinda H,Arirachakaran A,et al.Comparison of direct anterior,lateral,posterior and posterior-2 approaches in total hip arthroplasty:network meta-analysis[J].Eur J Orthop Surg Traumatol,2018,28(2):255-267.
[19]Reichert JC,Volkmann MR,Koppmair M,et al.Comparative retrospective study of the direct anterior and transgluteal approaches for primary total hip arthroplasty[J].Int Orthop,2015,39(12):2309-2313.
[20]Landgraeber S,Quitmann H,Güth S,et al.A prospective randomized peri-and post-operative comparison of the minimally invasive anterolateral approach versus the lateral approach[J/OL].Orthop Rev(Pavia),2013,5(3):e19.doi:10.4081/or.2013.e19.
[21]Van Oldenrijk J,Hoogland PV,Tuijthof GJ,et al.Soft tissue damage after minimally invasive THA[J].Acta Orthop,2010,81(6):696-702.
[22]Apple FS,Rhodes M.Enzymatic estimation of skeletal muscle damage by analysis of changes in serum creatine kinase[J].J Appl Physiol,1988,65(6):2598-2600.
[23]Byrnes WC,Clarkson PM,White JS,et al.Delayed onset muscle soreness following repeated bouts of downhill running[J].J Appl Physiol,1985,59(3):710-715.
[24]Teet JS,Skinner HB,Khoury L.The effect of the“mini”incision in total hip arthroplasty on component position[J].J Arthroplasty,2006,21(4):503-507.doi:10.1016/j.arth.2005.06.011.
[25]D’lima DD,Urquhart AG,Buehler KO,et al.The effect of the orientation of the acetabular and femoral components on the range of motion of the hip at different head-neck ratios[J].J Bone Joint Surg Am,2000,82(3):315-321.
[26]古明晖,张志奇,何爱珊,等.骨盆倾斜角和骶骨倾斜角在合并脊柱疾病的患者行初次全髋关节置换术中的作用[J/CD].中华关节外科杂志(电子版),2013,7(2):134-137.
[27]Archibeck MJ,White RE.Learning curve for the two-incision total hip replacement[J].Clin Orthop Relat Res,2004,(429):232-238.
[28]Den Hartog YM,Mathijssen NM,Vehmeijer SB.The less invasive anterior approach for total hip arthroplasty:a comparison to other approaches and an evaluation of the learning curve-a systematic review[J].Hip Int,2016,26(2):105-120.
[29]Müeller DA,Zingg PO,Dora C.Anterior minimally invasive approach for total hip replacement:five-year survivorship and learning curve[J].Hip Int,2014,24(3):277-283.
[30]De Geest T,Fennema P,Lenaerts G,et al.Adverse effects associated with the direct anterior approach for total hip arthroplasty:a Bayesian meta-analysis[J].Arch Orthop Trauma Surg,2015,135(8):1183-1192.
[31]Spaans AJ,van den Hout JA,Bolder SB.High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach[J].Acta Orthop,2012,83(4):342-346.
[32]张先龙,沈灏,王琦,等.前外侧肌间隙入路微创全髋关节置换术的应用解剖与临床研究[J].中华骨科杂志,2007,27(4):268-272.