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

doi:10.3877/cma.j.issn.1674-134X.2019.02.002

中华关节外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (02) : 138 -144. doi: 10.3877/cma.j.issn.1674-134X.2019.02.002

所属专题：文献；

临床论著

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

张海宁¹^,^†(

), 孙一¹, 丁昌荣², 徐亦鹏³, 王英振¹

^1. 266000　青岛大学附属医院关节外科
^2. 266000　青岛大学附属医院特检科
^3. 061000　沧州市人民医院骨科

收稿日期:2018-07-10 出版日期:2019-04-01
通信作者: 张海宁
基金资助:
国家自然科学基金(81672197)

Short-term clinical outcome comparison between Bikini incision with anterior approach and orthopädische chirurgie München approach in total hip arthroplasty

Haining Zhang¹^,^†(), Yi Sun¹, Changrong Ding², Yipeng Xu³, Yingzhen Wang¹

^1. Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
^2. Department of Special Examination, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
^3. Department of Orthopaedic, Cangzhou People’s Hospital, Cangzhou 061000, China

Received:2018-07-10 Published:2019-04-01
Corresponding author: Haining Zhang
About author:
Corresponding author: Zhang Haining, Email: zhhaining@hotmail.com

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引用本文：

张海宁, 孙一, 丁昌荣, 徐亦鹏, 王英振. 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[J/OL]. 中华关节外科杂志(电子版), 2019, 13(02): 138-144.

Haining Zhang, Yi Sun, Changrong Ding, Yipeng Xu, Yingzhen Wang. Short-term clinical outcome comparison between Bikini incision with anterior approach and orthopädische chirurgie München approach in total hip arthroplasty[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(02): 138-144.

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。

关键词: 外科手术，微创性, 髋关节, 关节成形术

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.

Key words: Minimally invasive surgical procedures, Hip joint, Arthroplasty

图3 术后假体位置良好

表1 术前一般资料

组别	例数	年龄[岁，(±s)]	男性占比(%)	BMI[kg/m²，(±s)]	术前血红蛋白[g/L，(±s)]	Harris评分(±s)	VAS评分(±s)
Bikini组	40	66.3±9.7	57.5	26.7±4.0	129.3±11.8	58.4±10.6	9.0±1.4
OCM组	40	65.7±10.1	60.0	26.0±4.3	131.4±10.9	59.6±11.5	8.3±2.0
统计值	?	t＝0.262	χ²＝2.324	t＝0.825	t＝0.831	t＝0.507	t＝1.738
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表1 术前一般资料

组别	例数	年龄[岁，(±s)]	男性占比(%)	BMI[kg/m²，(±s)]	术前血红蛋白[g/L，(±s)]	Harris评分(±s)	VAS评分(±s)
Bikini组	40	66.3±9.7	57.5	26.7±4.0	129.3±11.8	58.4±10.6	9.0±1.4
OCM组	40	65.7±10.1	60.0	26.0±4.3	131.4±10.9	59.6±11.5	8.3±2.0
统计值	?	t＝0.262	χ²＝2.324	t＝0.825	t＝0.831	t＝0.507	t＝1.738
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表2 手术一般情况

组别	例数	手术时间[min，(±s)]	术中出血量[ml，(±s)]	术后引流量[ml, (±s)]	术后24 h血红蛋白值[g/L, (±s)]	输血率(%)	手术切口长度[cm, (±s)]	肢体不等长发生率(%)	住院天数[d, (±s)]
Bikini组	40	105.0±19.0	296.0±97.0	198.0±88.0	99.4±9.8	20.0	7.6±2.1	13.2	7.2±2.6
OCM组	40	109.0±20.0	309.0±89.0	207.0±92.0	100.5±8.2	13.3	8.1±1.9	19.7	7.5±2.0
统计值	?	t＝0.917	t＝0.625	t＝0.447	t＝0.544	χ²＝1.965	t＝1.117	χ²＝2.005	t＝0.578
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表2 手术一般情况

组别	例数	手术时间[min，(±s)]	术中出血量[ml，(±s)]	术后引流量[ml, (±s)]	术后24 h血红蛋白值[g/L, (±s)]	输血率(%)	手术切口长度[cm, (±s)]	肢体不等长发生率(%)	住院天数[d, (±s)]
Bikini组	40	105.0±19.0	296.0±97.0	198.0±88.0	99.4±9.8	20.0	7.6±2.1	13.2	7.2±2.6
OCM组	40	109.0±20.0	309.0±89.0	207.0±92.0	100.5±8.2	13.3	8.1±1.9	19.7	7.5±2.0
统计值	?	t＝0.917	t＝0.625	t＝0.447	t＝0.544	χ²＝1.965	t＝1.117	χ²＝2.005	t＝0.578
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表3 组内不同患者手术一般情况比较

Bikini组	手术时间[min，(±s)]	术中出血量[ml，(±s)]	术后引流量[ml, (±s)]	输血率(%)	OCM组	手术时间(min)	术中出血量(ml)	术后引流量(ml)	输血率(%)
前10例	120±16	369±101	268±96	30%	前10例	126±20	382±104	277±99	30%
后30例	97±19	241±91	146±84	15%	后30例	98±21	265±88	152±88	5%
统计值	t＝3.436	t＝3.751	t＝3.751	χ²＝1.1.69	统计值	t＝3.692	t＝3.481	t＝3.773	χ²＝3.334
P值	<0.01	<0.01	<0.01	>0.05	P值	<0.01	<0.01	<0.01	>0.05

表3 组内不同患者手术一般情况比较

Bikini组	手术时间[min，(±s)]	术中出血量[ml，(±s)]	术后引流量[ml, (±s)]	输血率(%)	OCM组	手术时间(min)	术中出血量(ml)	术后引流量(ml)	输血率(%)
前10例	120±16	369±101	268±96	30%	前10例	126±20	382±104	277±99	30%
后30例	97±19	241±91	146±84	15%	后30例	98±21	265±88	152±88	5%
统计值	t＝3.436	t＝3.751	t＝3.751	χ²＝1.1.69	统计值	t＝3.692	t＝3.481	t＝3.773	χ²＝3.334
P值	<0.01	<0.01	<0.01	>0.05	P值	<0.01	<0.01	<0.01	>0.05

表4 术后Harris评分和VAS评分比较(±s)

组别	例数	Harris评分				VAS评分		直腿抬高功能锻炼时间(d)	髋关节主动外展时间(d)
组别	例数	术后2周	术后6周	术后3个月	术后6个月	术后24 h	术后6周	直腿抬高功能锻炼时间(d)	髋关节主动外展时间(d)
Bikini组	40	67.0±13.0	86.0±12.0	93.0±10.0	96.0±9.0	4.0±1.3	1.8±0.6	1.1±0.9	1.4±0.7
OCM组	40	71.0± 14.0	81.0±13.0	91.0±9.0	94.0±9.0	3.9±1.2	1.9±0.5	1.5±1.0	2.3±0.6
统计值	?	t＝1.324	t＝1.787	t＝0.940	t＝0.994	t＝0.358	t＝0.470	t＝1.880	t＝6.174
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.01

表4 术后Harris评分和VAS评分比较(±s)

组别	例数	Harris评分				VAS评分		直腿抬高功能锻炼时间(d)	髋关节主动外展时间(d)
组别	例数	术后2周	术后6周	术后3个月	术后6个月	术后24 h	术后6周	直腿抬高功能锻炼时间(d)	髋关节主动外展时间(d)
Bikini组	40	67.0±13.0	86.0±12.0	93.0±10.0	96.0±9.0	4.0±1.3	1.8±0.6	1.1±0.9	1.4±0.7
OCM组	40	71.0± 14.0	81.0±13.0	91.0±9.0	94.0±9.0	3.9±1.2	1.9±0.5	1.5±1.0	2.3±0.6
统计值	?	t＝1.324	t＝1.787	t＝0.940	t＝0.994	t＝0.358	t＝0.470	t＝1.880	t＝6.174
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.01

表5 血清学指标比较(±s)

组别	例数	术后当天CK变化量(u/L)	术后1 d CK变化量(u/L)	术后2 d CK变化量(u/L)	术后当天CRP变化量(mg/dl)	术后1 d CRP变化量(mg/dl)	术后2 d CRP变化量(mg/dl)
Bikini组	40	50±15	105±38	90±36	22±7	39±12	33±9
OCM组	40	87±61	177±51	130±43	35±10	59±21	49±16
t值	?	3.676	7.066	4.504	6.309	5.229	5.493
P值	?	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05

表5 血清学指标比较(±s)

组别	例数	术后当天CK变化量(u/L)	术后1 d CK变化量(u/L)	术后2 d CK变化量(u/L)	术后当天CRP变化量(mg/dl)	术后1 d CRP变化量(mg/dl)	术后2 d CRP变化量(mg/dl)
Bikini组	40	50±15	105±38	90±36	22±7	39±12	33±9
OCM组	40	87±61	177±51	130±43	35±10	59±21	49±16
t值	?	3.676	7.066	4.504	6.309	5.229	5.493
P值	?	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05

表6 组内不同患者间髋臼外展角和前倾角的比较(±s)

Bikini组	髋臼外展角(°)	髋臼前倾角(°)
前10例	51±7	7±3
后30例	41±6	14±5
t值	4.275	3.895
P值	<0.01	<0.01
OCM组	髋臼外展角(°)	髋臼前倾角(°)
前10例	48±8	5±4
后30例	40±6	12±6
t值	3.505	3.346
P值	<0.01	<0.01

表6 组内不同患者间髋臼外展角和前倾角的比较(±s)

Bikini组	髋臼外展角(°)	髋臼前倾角(°)
前10例	51±7	7±3
后30例	41±6	14±5
t值	4.275	3.895
P值	<0.01	<0.01
OCM组	髋臼外展角(°)	髋臼前倾角(°)
前10例	48±8	5±4
后30例	40±6	12±6
t值	3.505	3.346
P值	<0.01	<0.01

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Short-term clinical outcome comparison between Bikini incision with anterior approach and orthopädische chirurgie München approach in total hip arthroplasty

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Short-term clinical outcome comparison between Bikini incision with anterior approach and orthopädische chirurgie München approach in total hip arthroplasty