直接前入路双髋关节同时置换22例临床分析

发布时间：2018-04-05 19:27

本文选题：直接前入路　切入点：关节成形术　出处：《北京大学学报(医学版)》2017年02期

【摘要】：目的:通过分析直接前入路双髋关节同时置换的临床特点,探讨直接前入路双髋同时置换的手术技巧和避免围手术期并发症的方法。方法:回顾性分析2014年6月至2016年8月北京积水潭医院矫形骨科采用直接前入路双髋关节置换手术22例(44髋)患者的临床资料、手术效果及术后并发症等,其中男性17例,女性5例,年龄中位数为48岁(34~67岁)。股骨头缺血性坏死17例,髋关节发育不良继发性骨关节炎4例,类风湿性关节炎1例。所有患者采用平卧位直接前入路双髋关节同时置换手术治疗。结果:本组患者全部使用生物固定型假体。手术时间平均(167±23)min,术中出血量平均(775±300)m L,术中及术后输异体血平均(327±341)m L,术后伤口引流平均(111±73)m L。术后第1天多数患者可以不需要帮助自行上下病床,5例患者术后第1天可以不用拐杖短距离行走,术后3 d有13例患者可以在保护下做下蹲动作。术后平均4 d出院,平均随访时间16个月(8~24个月)。术中出现2例大粗隆骨折,3例阔筋膜张肌损伤。术后随访3例伤口延迟愈合,4例出现股外侧皮神经麻痹症状,2例患者大腿痛,无松动感染失败病例。Harris评分从术前平均(29±8)分,提高到术后平均(91±3)分,同术前相比差异有统计学意义(P0.01)。结论:直接前入路双髋关节置换术后早期患者恢复快,髋关节活动度好,但手术难度较高,在良好选择病例的情况下,术者在使用这种入路的早期仍然容易出现并发症。
[Abstract]:Objective: to analyze the clinical features of direct anterior approach for simultaneous hip replacement and to explore the surgical techniques and methods of avoiding perioperative complications.Methods: from June 2014 to August 2016, the clinical data of 22 patients (44 hips) with double hip replacement by direct anterior approach in orthopedic department of Beijing Jishuitan Hospital were retrospectively analyzed.Five cases were female, the median age was 48 years old and 34 67 years old.There were 17 cases of avascular necrosis of femoral head, 4 cases of secondary osteoarthritis and 1 case of rheumatoid arthritis.All patients were treated by direct anterior-approach hip replacement in supine position.Results: all patients were treated with biological fixed prosthesis.The mean operative time was 167 卤23 min, the average amount of blood lost during operation was 775 卤300mL, the average blood transfusion during and after operation was 327 卤341mL, and the average postoperative wound drainage was 111 卤73mL.On the first day of operation, most of the patients could walk without crutches on the first day of operation, and 13 patients could do squatting under protection on the third day after operation.The average postoperative discharge was 4 days, and the average follow-up time was 16 months, ranging from 8 to 24 months.There were 2 cases of great trochanter fracture and 3 cases of fascia lata tensor injury.3 cases of delayed wound healing and 4 cases with symptoms of lateral femoral cutaneous nerve palsy were followed up. In 2 cases, thigh pain was found. The Harris score of failure cases without loosening infection increased from 29 卤8 points before operation to 91 卤3 points after operation.The difference was statistically significant compared with that before operation (P 0.01).Conclusion: after direct anterior approach of double hip arthroplasty, the patients recovered quickly and the hip joint motion was good, but the operation was difficult. In the case of good selection of cases, complications were still easy to occur in the early stage of using this approach.
【作者单位】：北京积水潭医院矫形骨科;
【基金】：2015年度人力资源和社会保障部留学人员科技活动项目([2015]192)择优资助~~
【分类号】：R687.4

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