[1]姚孟轩 吴涛 韩永台 王宇钏 刘小庆 李向科 李振中 胡鸿鹏 李会杰.CFP假体在后外侧微创入路全髋关节置换术中的应用[J].中华老年骨科与康复电子杂志,2019,(03):155-161.[doi:DOI：10.3877/cma.j.issn.2096-0263.2019.006]
　Yao Mengxuan,Wu Tao,Han Yongtai,et al.Application of CFP prosthesis in posterior lateral minimally invasive total hip arthroplasty[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(03):155-161.[doi:DOI：10.3877/cma.j.issn.2096-0263.2019.006]
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CFP假体在后外侧微创入路全髋关节置换术中的应用
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2019年03期
页码:
155-161
栏目:
髋关节
出版日期:
2019-06-05

文章信息/Info

Title:
Application of CFP prosthesis in posterior lateral minimally invasive total hip arthroplasty
作者:
姚孟轩 吴涛 韩永台 王宇钏 刘小庆 李向科 李振中 胡鸿鹏 李会杰
作者单位：050051 石家庄，河北医科大学第三医院骨病科
Author(s):
Yao Mengxuan;  Wu Tao;  Han Yongtai;  Wang Yuchuan;  Liu Xiaoqing;  Li Xiangke;  Li Zhenzhong;  Hu Hongpeng;  Liu Zeming.
Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
关键词:
【关键词】 微创手术;  关节成形术; 置换; 髋;  CFP
Keywords:
【Key words】 Minimally invasive surgical procedures;  Arthroplasty;  replacement;  hip;  CFP
DOI:
DOI：10.3877/cma.j.issn.2096-0263.2019.006
文献标志码:
A
摘要:

【摘要】 目的 分析结合CFP假体特点并保留部分外旋肌群的改良后外侧入路微创全髋关节置换术的短期随访结果，同时对其可行性进行探讨和分析。方法 纳入自2017年10月至2018年2月在河北医科大学第三医院骨病科，诊断为缺血性股骨头坏死、髋关节骨性关节炎、头下型股骨颈骨折、股骨颈骨折术后股骨头坏死、先天性髋关节发育不良伴创伤性关节炎采用CFP假体经改良后外侧入路微创全髋关节置换术的病例，排除有髋关节化脓性感染史，结核性髋关节炎病史、头颈型和基底型股骨颈骨折的病例，共纳入46例（46髋），男性20例，女性26例；年龄60～81岁，平均年龄（72±8）岁。记录本组病例手术用时、切口长度、出血量、住院天数、术后并发症、影像学评价，通过单因素方差分析比较髋关节置换术前术后疼痛的改善和髋关节功能的恢复情况。结果 46例病例均获得随访，随访时间平均（11.5±0.8）个月，手术用时、切口长度、出血量、住院天数分别为（77±15）min，（8.5±1.3）cm，（280±65）ml，（7.1±0.9）d。末次随访时Trendelenburg阳性检出率为2.2%（1/23）。术前、术后1 d、4 d、7 d、1个月、3个月、6个月、末次随访髋关节Harris评分分别平均为（52.8±15.9）分、（35.5±7.7）分、（63.8±15.2）分、（74.1±8.5）分、（80.0±4.7）分、（88.9±5.1）分、（92.5±4.9）分、（93.3±4.7）分，（F=112.5，P＜0.01）；术前、术后1 d、4 d、7 d、1个月、3个月、6个月、末次随访Barthel指数分别平均为（87.6±15.8）分、（34.1±8.2）分、（68.7±9.6）分、（76.3±6.6）分、（84.6±6.9）分、（90.9±6.9）分、（95.7±6.1）分、（95.9±6.7）分，（F=142.0，P＜0.01）。术前、术后1 d、4 d、7 d、1月、3月、6月、末次随访疼痛视觉模拟评分（VAS）评分分别平均为（6.6±1.5）分、（4.9±1.2）分、（3.5±1.0）分、（2.4±0.8）分、（1.6±0.6）分、（1.1±0.6）分、（0.6±0.5）分、（0.6±1.3）分、（F=160.8，P＜0.01）；术后拍摄标准的骨盆正位、置换侧的股骨正侧位、双下肢拼接正位，双下肢长度差值（5.2±2.8）mm，髋臼外展角（45.0±5.4）°，双侧股骨偏心距的差值（4.3±2.1）mm和髋臼的前倾角（18.9±6.4）°。术后未发生假体脱位、假体周围骨折，伤口感染、坐骨神经损伤、深静脉血栓、脑栓塞及肺栓塞并发症。结论 结合CFP假体特点，改良后外侧入路微创全髋关节置换术创伤小，可保留部分外旋肌群，改善术后疼痛及加快功能康复，是一个安全可行的微创全髋关节置换手术技术。

Abstract:

【Abstract】 Objective The short-term follow-up results of the modified posterolateral approach minimally invasive total hip arthroplasty with the characteristics of CFP prosthesis combined with the preservation of partial external rotation muscle group were discussed and analyzed. Methods Retrospective analysis was done in the Department of Orthopaedics, the Third Hospital of Hebei Medical University from October 2017 to February 2018, patients diagnosed with ischemic femoral head necrosis, hip osteoarthritis, subtrochanteric femoral neck fracture, femoral neck fracture Femoral head necrosis, congenital hip dysplasia with traumatic arthritis were treated with modified posterior approach minimally invasive total hip arthroplasty with CFP prosthesis, excluding history of hip purulent infection, history of tuberculous hip arthritis There were 46 cases (46 hips) with head and neck and basal femoral neck fractures, 20 males and 26 females, aged 60-81 years, the mean age was (72±8) years old. The surgical time, length of incision, amount of bleeding, length of hospital stay, postoperative complications, and imaging evaluation were recorded. The improvement of pain before and after hip replacement and the recovery of hip function were compared by one-way analysis of variance. Results All the 46 cases were followed up for (11.5±0.8) months. The time of operation, length of incision, amount of bleeding, and length of hospital stay were (77±15) min, (8.5±1.3) cm, (279.5±65.1) ml, (7.1±0.9) d. The positive rate of Trendelenburg at the last follow-up was 2.2%(1/23). The hip Harris scores before and after 1 d, 4 d, 7 d, 1 m, 3 m, 6 m, and the last follow-up were (52.8±15.9), (35.5±7.7), (63.8±15.2), (74.1±8.5), (80.0±4.7), (88.9±5.1), (92.5±4.9), (93.3±4.7) (F=112.5, P<0.01). Preoperative, postoperative 1 d, 4 d, 7 d, In January, March, June, and the last follow-up, the Barthel index averaged were (87.6±15.8), (34.1±8.2), (68.7±9.6), (76.3±6.6), (84.6±6.9), and (90.9±6.9), (95.7±6.1), (95.9±6.7)，(F=142.0, P<0.01). The visual analogue scale (VAS) scores of preoperative, postoperative 1 d, 4 d, 7 d, 1 m, 3 m, 6 m, and last follow-up were (6.6±1.5), (4.9±1.2), and (3.5±1.0), (2.4±0.8), (1.6±0.6), (1.1±0.6), (0.6±0.5), (0.6±1.3), (F=160.8, P<0.01). Standard posterior pelvis , anterior posterior femur on the replacement side, orthogonal splicing of lower limbs X-ray after surgery were achieved, difference in length of the lower limbs was (5.2±2.8) mm, acetabular abduction angle was (45.0±5.4)°, difference in bilateral femoral eccentricity was (4.3±2.1) mm and the anteversion angle of the acetabulum was (18.9±6.4)°. There were no prosthesis dislocation, periprosthetic fracture, wound infection, sciatic nerve injury, deep vein thrombosis, cerebral embolism and pulmonary embolism occurred. Conclusion Combined with the characteristics of CFP prosthesis, the modified posterior approach minimally invasive total hip arthroplasty has small trauma, can retain part of the external rotation muscle group, improve postoperative pain and accelerate functional recovery. It is a safe and feasible minimally invasive total hip arthroplasty. technology.

参考文献/References:


1 Xie J, Zhang HX, Wang L, et al. Comparison of supercapsular percutaneously assisted approach total hip versus conventional posterior approach for total hip arthroplasty: a prospective, randomized controlled trial [J]. J Orthop Surg Res, 2017, 12(1): 138.
2 Free MD, Owen DH, Agius PA, et al. Direct Anterior Approach Total Hip Arthroplasty: An Adjunct to an Enhanced Recovery Pathway: Outcomes and Learning Curve Effects in Surgeons Transitioning From Other Surgical Approaches [J]. The Journal of arthroplasty, 2018. 33(11): 3490-3495.
3 Repantis TB, Korovessis P. Comparison of minimally invasive approach versus conventional anterolateral approach for total hip arthroplasty:a randomized controlled trial [J]. Eur J Orthop Surg Traumatol, 2015, 25(1): 111-116.
4 Xie J, Zhang HX, Wang L, et al. Comparison of supercapsular percutaneously assisted approach total hip versus conventional posterior approach for total hip arthroplasty: a prospective, randomized controlled trial [J]. J Orthop Surg Res, 2017, 12(1): 138.
5 Hartzband MA. Posterolateral minimal incision for total hip replacement: technique and early results [J]. Orthop Clin North Am, 2004, 35(2): 119 -29.
6 Bodrogi AW, Sciortino R, Fitch DA, et al. Use of the supercapsular percutaneously assisted total hip approach for femoral neck fractures: surgical technique and case series [J]. J Orthop Surg Res, 2016, 11(1): 113.
7 Rosenlund, S. The efficacy of modified direct lateral versus posterior approach on gait function and hip muscle strength after primary total hip arthroplasty at 12months follow-up. An explorative randomised controlled trial [J]. Clin Biomech(Bristol,Avon), 2016, 39(11): 91-99.
8 Nistor VD. Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon? [J]. Int Orthop, 2017, 41(11): 2245-2252.
9 李亚民, 彭晓春, 王俏杰, 等. 经皮辅助关节囊入路微创人工全髋关节置换术 [J]. 中华关节外科杂志(电子版), 2018. 12(01): 1-7.
10 李振刚. 保留股骨颈全髋关节置换术的临床疗效分析 [J]. 中国骨与关节损伤杂志, 2012, 27(8): 712-713.
11 Della Valle CJ, Dittle E, Moric M, et al. A prospective randomized trial of mini-incision posterior and two-incision total hip arthroplasty [J]. Clin Orthop Relat Res, 2010, 468(12): 3348-3354.
12 Cheng T, Feng JG, Liu T, et al. Minimally invasive total hip arthroplasty: a systematic review [J]. Int Orthop, 2009, 33(6): 1473-1481.
13 Thürig G, Schmitt JW, Slankamenac K, et al. Safety of total hip arthroplasty for femoral neck fractures using the direct anterior approach: a retrospective observational study in 86 elderly patients [J]. Patient Saf Surg, 2016, 10(1): 12.
14 Fink B, Mittelstaedt A. Minimally invasive posterior approach for total hip arthroplasty [J]. Orthopade, 2012. 41(5): 382-9.
15 Rajakulendran K, Field R.E. Neck-Preserving Femoral Stems [J]. HSS J, 2012. 8(3): 295-303.
16 Li MQ, Hu YH, Xie J. Analysis of the complications of the collum femoris preserving (CFP) prostheses [J]. Acta Orthop Traumatol Turc, 2014, 48(6): 623-627.
17 Murphy SB, Tannast M, THA performed using conventional and navigated tissue-preserving techniques [J]. Clin Orthop Relat Res, 2006, 453(453): 160-167.
18 陈述祥. 后外侧入路微创小切口人工全髋关节置换术 [J]. 中国矫形外科杂志, 2010, 18(16): 1389-1391.
19 Jacquot F, Mokhtar MA, Sautet AA, et al. The mini postero-postero-lateral mini incision in total hip arthroplasty [J]. Int Orthop, 2013, 37(10): 1891-1895.ncision in total hip arthroplasty [J]. Int Orthop, 2013, 37(10): 1891-1895.
20 Moskal JT, Capps SG. Is limited incision better than standard total hip arthroplasty? A meta-analysis [J]. Clin Orthop Relat Res, 2013, 471(4): 1283-1294.
21 Migliorini F, Biagini M, Rath B, et al. Total hip arthroplasty: minimally invasive surgery or not? Meta-analysis of clinical trials [J]. Int Orthop, 2018: 1-10.
22 Vicente, N JR, Miyahara HS, Luzo CM, et al. Total hip arthroplasty using a posterior minimally invasive approach–results after six years [J]. Rev Bras Ortop, 2015, 50(1): 77-82.
23 Winther BS. Husby VS, Foss OA, et al. Muscular strength after total hip arthroplasty:a prospective comparison of 3 surgical approaches [J]. Acta Orthop, 2016, 87(1): 22-28.
24 Schmolders J, Gravius S, Wirtz DC. Significance of Minimally Invasive Approaches during Primary Hip Arthroplasty - an Update [J]. Z Orthop Unfall. 2014, 152(02): 120-129.
25 Schwarze M, Budde S, von Lewinski G, et al. No effect of conventional vs. minimally invasive surgical approach on clinical outcome and migration of a short stem total hip prosthesis at 2-year follow-up: A randomized controlled study. Clin Biomech (Bristol, Avon), 2018. 51: 105-112.

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备注/Memo

备注/Memo:

基金项目：专科能力建设和专科带头人培养项目
更新日期/Last Update: 2019-07-09