人工全髋关节置换术Watson-Jones入路、Moore入路的临床疗效分析
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摘要
目的:通过对外侧入路(Watson-Jones)、后侧入路(Moore)二种不同入路进行人工全髋关节置换术(Total Hip Arthroplsty,THA)的疗效比较,探讨各自优缺点及适应症,并作理论分析,为临床病症选择适合的手术入路提供依据。方法:采用回顾性分析方法,分析我院在2006年6月至2008年3月采用外侧入路(Watson-Jones)、后侧入路(Moore)二种不同入路治疗的50例人工全髋关节置换(Total Hip Arthroplsty,THA)病人的临床资料及放射结果,其中外侧入路组25例,后侧入路组25例,并经门诊复诊及通讯方式随访2个月至1.5年,平均3个月。从手术过程、并发症发生率、平均下床负重时间、髋关节功能恢复情况(优良率)等方面对二种不同髋关节手术入路进行比较评价,并作统计学分析。结果:二组在年龄和性别方面无显著差异(P>0.05)。在切口长度、手术时间、术中出血量、输血量、术后引流量、下床负重时间有明显差异(P<0.01)。在术中神经损伤、切口感染率、术后脱位发病率方面有统计学差异(P<0.05)。在髋关节功能恢复方面,外侧入路组优良率为88%,后侧入路组优良率为84%。结论:在全髋关节置换术中,以髋关节外侧入路(Watson-Jones)为最佳,其次为髋关节后侧入路(Moore)
Objective: Comparison of effect of the Lateral approach(Watson-Jones)and Posterior approach(Moore)on Total Hip Arthroplsty. Discussion on each of advantages and disad- vantages, each of indication. And make theoretical analysis, provide evidence for appro- priate surgical approach on clinical disease. Methods: Using retrospective analysis on 50 cases of hospitalised patientˊs clinical data and radiation result of the Lateral approach (Watson-Jones)and Posterior approach(Moore)on Total Hip Arthroplsty, during the period from June 2006 to March 2008,25 cases of the Lateral approach (Watson-Jones)and 25 cases of Posterior approach(Moore). Through out-patients return- visit and communication way follow-up from 2 months to 1.5 years, the average is 3 months. By comparing and statistical analysis to two different surgical approaches in the average hospitalisation period operative process,incidence of complication and information of the total hip functional recovery. Results: The two groups have no obvious difference in incidence of the age and sex. They have obvious difference in the length of incision, the time of surgery, the blood loss, the blood transfusion, the postoperative drainages, the time of ground activity (P<0.01). They have statistical difference in incidence of the nerve injury, the incision infection after operation, the dislocation after operation (P<0.05). Excellent or good rate of the function of the hip joint was 88% in the Lateral approach,was 84% in the Posterior approach.Conclusion: The Lateral approach (Watson- Jones)is the first selection, the Posterior approach(Moore)is the second selection on the Total Hip Arthroplsty.
Objective: Comparison of effect of the Lateral approach(Watson-Jones)and Posterior approach(Moore)on Total Hip Arthroplsty. Discussion on each of advantages and disad- vantages, each of indication. And make theoretical analysis, provide evidence for appro- priate surgical approach on clinical disease. Methods: Using retrospective analysis on 50 cases of hospitalised patientˊs clinical data and radiation result of the Lateral approach (Watson-Jones)and Posterior approach(Moore)on Total Hip Arthroplsty, during the period from June 2006 to March 2008,25 cases of the Lateral approach (Watson-Jones)and 25 cases of Posterior approach(Moore). Through out-patients return- visit and communication way follow-up from 2 months to 1.5 years, the average is 3 months. By comparing and statistical analysis to two different surgical approaches in the average hospitalisation period operative process,incidence of complication and information of the total hip functional recovery. Results: The two groups have no obvious difference in incidence of the age and sex. They have obvious difference in the length of incision, the time of surgery, the blood loss, the blood transfusion, the postoperative drainages, the time of ground activity (P<0.01). They have statistical difference in incidence of the nerve injury, the incision infection after operation, the dislocation after operation (P<0.05). Excellent or good rate of the function of the hip joint was 88% in the Lateral approach,was 84% in the Posterior approach.Conclusion: The Lateral approach (Watson- Jones)is the first selection, the Posterior approach(Moore)is the second selection on the Total Hip Arthroplsty.
引文
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[20] Woo RYG, Morrey BR Dislocations after total hip arthroplasty[J].J Bone Joint Surg, 1982;(64A):1295～1306.
[21] Etienne A, Cupic Z, Charnley J. Postoperative dislocation after Charnley low-friction arthroplasty[J]. Clin Orthop, 1978;(132):19～23.
[22]赵忠岳,李世民主编.关节外科学,天津:天津科学技术出版社,2002.第一版:1031.
[23] Harris WH. Advances in surgical technique for total hip replacement [J].Clin Orthop, 1980;(146):188～204.
[24] Lewinnek GE, Lewis J L, Tarr R, et al. Dislocations after total hip replacement arthroplasty[J]. J Bone Joint Surg(Am), 1978;(6):217～220.
[25]陈是煌,贾正平.全髋关节置换手术入路对老年患者疗效的分析.实用骨科杂志,2002;8(4):280～281.
[26] Anja SP. Leg length discrepancies. Total hip replacement. Ed by Ochsner P.E.1ed.Berlin: Springer, 2002:137～145.
[27]王建华,吴岳嵩,徐卫东,等.人工全髋关节置换术后髋关节脱位的防治策略[J].中华骨科杂志,2000;20(4):214.
[28]李福春,孙国民,全髋关节置换术治疗髋关节病体会.辽宁医学杂志,2001;15(4):218.
[29]徐辉,张洪,王金城,等.人工髋关节置换术所致神经损伤.中华骨科志,1994;14(3):268.
[30]冯传汉,张铁良.临床骨科学.北京:人民卫生出版社,20O4.第2版:107.
[31]贾世,孔肖晨.人工髋关节置换术并发症及防治.天津医药,2007;8(35)8:629.
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[34]叶斌,于光生.髋关节后侧入路应用解剖.解剖与临床,2006;11(3):149.
[35]熊刚,黄强民,徐恒旭,等.68例外侧切口全髋关节置换的临床观察和分析[A].玉溪市第二届骨科学术研讨及科技成果推广会论文汇编[C],2005:174～178.
[36]曾文胜,罗建平.后侧入路行全髋置换11例.衡阳医学院学报,2000;28(4):4.
[1]郭炯炯,杨惠林,唐天驯.小切口全髋置换术.中华创伤杂志2004;20, (23):15.
[2]郭传友,段以祥.小切口人工全髋关节置换术.中华矫形外科杂志, 2004;7(10):63.
[3] Sculco TP,Jordan LC,Walter WL. Minimally invasive total hip arthroplasty: the Hospital for Special Surgery experience. Orthoo Clin North Am. 2004;(35):137～142.
[4]张宏伟,李春明.小切口人工髋关节置换术65例临床报道.中国社区医师,2008;9(171):29.
[5]于凤宾,吴岳嵩,王志伟,等.小切口技术在全髋关节置换术的应用.中国骨与关节损伤杂志,2006;21(8):597.
[6] Bottner F,Delgado S, Seuleo TP.Minimally invasive total hip replacement:the postero lateral approach. Am,J Orthop, 2006;35(5):218.
[7] Berger RA.Mini-incisions:two for the price of one Orthopedic, 2002;(25):472～483.
[8] Woolson ST,Mow CS, Syquia,JF, et al. Comparison of primary total hip replacements performed with a standard incision or a mini-incision Bone Joint Surg (Am), 2004;86(7):1353.
[9] Berger RA.Mini-incision total hip replacement using an anterolateral approach. technique and results. Orthop Clin North Am. 2004;(35):143～151.
[10]罗先正,邱贵兴,主编.人工髋关节学[M].北京:中国协和医科大学出版社,2003.第一版:5.
[11] Pavone V, Chimento G, Sharrock N, et al. The role of incision total hip arthroplasty. J Bone Joint Surg(Br), 2001;(83):213～217.
[12] Schofield SF.Minimally invasive surgery forhip replacement. ANZ J Surg, 2004;(74):287～288.
[13]金大地.关于微创人工全髋关节置换术的若干问题[J].中华外科杂志,2006;(44):509～511.
[14] Benin KC,RottingerH. Anterolateral mini-incision hip replacement surgery:amodified Watson-Jone.ClinOrthop, 2004;(429):248-255.
[15] Chimento CF,Pavone V,Sharrock N,et al. Minimally invasive total hip arthroplasty:aprospective randomized study. J Arthroplasty, 2005;(20):139～144.
[16] Nakamura S, Matsuda K, Arai N, et al. Mini-incision posterior approach for total hip arthroplasty. Int Orthop, 2004;(28):214～217.
[17] Dorr LD. Comparison of primary total hip replacements performed with a standard incision or a mini-incision. J Bone Joint Surg(Am),2005;(87):675～676.
[18] Sculco TP. Minimally invasive total hip arthroplasty: in the affirmative. J Arthroplasty, 2004;19(4 Suppl 1):78～80.
[19] Siguier T,Siguier M,Brumpt B. Mini-incision anterior approachdoes not increase dislocation rate: a study of 1037 total hip replacemenT. Clin Orthop Relat Res,2004;(426):164～173.
[20] Ogonda L,Wilson R, Archbold P, et al. A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes.aprospective, randomized, controlled trial. J Bone Joint Surg(Am), 2005;(87):701～710.
[21]沈彬,裴福兴.微创与常规全髋关节置换术的比较研究.中华骨科杂志2007;27(10):726.
[22] Berger RA, Jacobs JJ, Meneghini RM, et al. Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop Relat Res, 2004;(429):239～247.
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[26] Fehring TK, Mason JB.Catastrophic complications of minimally invasive hip surgery. a series of three cases. J Bone Joint Surg(Am), 2005;(87):711～714.
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[28] Ogonda L, Wikon R,Archbold P, eta.1A minimal-incision technique in total hiparthroplasty does not improve early postoperative outcomes Aprospective randomized controlled trial. Jbone Joint Surg(Am), 2005; (87):701～710.
[29] Chimento GF, Pavone V, Sharrock N, et al.Minimally invasive total arthroplasty, a prospective randomized study.J Arthroplasty, 2005;(20):139～144.
[30]姜华伟.小切口人工全髋关节置换术24例分析,大连医科大学硕士论文.2007:8～13.
[31]万豫尧,李晓初.小切口人工全髋关节置换术的应用.中医正骨,2004;16 (1):19.
[32]梁胜根,付朝华.小切口与传统切口在全髋关节置换术中的临床疗效分析.岭南现代临床外科,2007;7,(4):286.
[2]胥少汀,葛宝丰,徐印坎.实用骨科学,北京:人民军医出版社,2005.第3版:2103～2112.
[3]刘明,李佩佳.全髋关节置换术.中国矫形外科杂志,2004;12(15):1178.
[4]苗华,周建生.骨科手术入路解剖学[M],合肥:安徽科学技术出版社,1995.第一版:346～356.
[5]邹天明.髋关节置换的切口选择.苏州医学,2006;29(1):3.
[6] Moo BF. Instability after total hip arthrophasty[J]. clin Orthop, 1992;(23):237～248.
[7] Herverts P. Hip arthroplasty revision (editional)[J]. Acta Orthop Scand 1992;2(6):109.
[8]白希壮.人工全髋置换术疗效分析.中华骨科杂志,1995;(8):491.
[9] S.Terry Canale主编.卢世璧主译.坎贝尔骨科手术学.济南:山东科学技术出版社,2001.第九版:285.
[10]吕厚山.浅谈人工股骨头置换治疗股骨颈骨折[J].中华骨科杂志,1997;17(2):99.
[11] Squires B, Baneister G. Displaced intrecapsular neck of femur fractures in mobile independent patients Total hip replacement orthop arthroplasty[J]. Injury. 1999; 30(5):345～348.
[12]禹旭.高龄患者人工髋关节置换术前评估.第一军医大学学报,2001;24(8):967.
[13] Hardinge K. The direct lateral approach to the hip[J]. J Bone Joint Surg. 1982;(64-B):17～19.
[14]何爱咏.全髋置换术中三种切口的局解与手术损伤比较.中国局解手术学杂志,1998;8(3):210.
[15]朱通伯,戴克戎.骨科手术学[M].北京:人民卫生出版社,1998.第2版:331.
[16]原晓景.髋关节血供与手术入路关系的应用解剖及影像学研究,第二军医大学博士论文.2006:3～7.
[17] Etienne A, Cupic Z, Charnley J. Postoperative dislocation after charley low-friction arthroplasty[J]. Clin Orthop, 1978;(132):19～32.
[18] Mccollum DE, Gray W. Dislocation after total hip arthroplasty[J]. Clin Orthop, 1990;(261):159～170.
[19]吴义龙,梁国伟.人工髋关节置换术后早期脱位原因探讨及防治.实用骨科杂志,2007;13(8):479.
[20] Woo RYG, Morrey BR Dislocations after total hip arthroplasty[J].J Bone Joint Surg, 1982;(64A):1295～1306.
[21] Etienne A, Cupic Z, Charnley J. Postoperative dislocation after Charnley low-friction arthroplasty[J]. Clin Orthop, 1978;(132):19～23.
[22]赵忠岳,李世民主编.关节外科学,天津:天津科学技术出版社,2002.第一版:1031.
[23] Harris WH. Advances in surgical technique for total hip replacement [J].Clin Orthop, 1980;(146):188～204.
[24] Lewinnek GE, Lewis J L, Tarr R, et al. Dislocations after total hip replacement arthroplasty[J]. J Bone Joint Surg(Am), 1978;(6):217～220.
[25]陈是煌,贾正平.全髋关节置换手术入路对老年患者疗效的分析.实用骨科杂志,2002;8(4):280～281.
[26] Anja SP. Leg length discrepancies. Total hip replacement. Ed by Ochsner P.E.1ed.Berlin: Springer, 2002:137～145.
[27]王建华,吴岳嵩,徐卫东,等.人工全髋关节置换术后髋关节脱位的防治策略[J].中华骨科杂志,2000;20(4):214.
[28]李福春,孙国民,全髋关节置换术治疗髋关节病体会.辽宁医学杂志,2001;15(4):218.
[29]徐辉,张洪,王金城,等.人工髋关节置换术所致神经损伤.中华骨科志,1994;14(3):268.
[30]冯传汉,张铁良.临床骨科学.北京:人民卫生出版社,20O4.第2版:107.
[31]贾世,孔肖晨.人工髋关节置换术并发症及防治.天津医药,2007;8(35)8:629.
[32]毛宾尧.人工髋关节外科学.北京:人民卫生出版社,2002.第二版:307～387.
[33]兰宝金,陈玲珑,殷林,等.髋关节外侧入路安全区的解剖定位与临床应用.解剖科学进展,2002;8(2):2.
[34]叶斌,于光生.髋关节后侧入路应用解剖.解剖与临床,2006;11(3):149.
[35]熊刚,黄强民,徐恒旭,等.68例外侧切口全髋关节置换的临床观察和分析[A].玉溪市第二届骨科学术研讨及科技成果推广会论文汇编[C],2005:174～178.
[36]曾文胜,罗建平.后侧入路行全髋置换11例.衡阳医学院学报,2000;28(4):4.
[1]郭炯炯,杨惠林,唐天驯.小切口全髋置换术.中华创伤杂志2004;20, (23):15.
[2]郭传友,段以祥.小切口人工全髋关节置换术.中华矫形外科杂志, 2004;7(10):63.
[3] Sculco TP,Jordan LC,Walter WL. Minimally invasive total hip arthroplasty: the Hospital for Special Surgery experience. Orthoo Clin North Am. 2004;(35):137～142.
[4]张宏伟,李春明.小切口人工髋关节置换术65例临床报道.中国社区医师,2008;9(171):29.
[5]于凤宾,吴岳嵩,王志伟,等.小切口技术在全髋关节置换术的应用.中国骨与关节损伤杂志,2006;21(8):597.
[6] Bottner F,Delgado S, Seuleo TP.Minimally invasive total hip replacement:the postero lateral approach. Am,J Orthop, 2006;35(5):218.
[7] Berger RA.Mini-incisions:two for the price of one Orthopedic, 2002;(25):472～483.
[8] Woolson ST,Mow CS, Syquia,JF, et al. Comparison of primary total hip replacements performed with a standard incision or a mini-incision Bone Joint Surg (Am), 2004;86(7):1353.
[9] Berger RA.Mini-incision total hip replacement using an anterolateral approach. technique and results. Orthop Clin North Am. 2004;(35):143～151.
[10]罗先正,邱贵兴,主编.人工髋关节学[M].北京:中国协和医科大学出版社,2003.第一版:5.
[11] Pavone V, Chimento G, Sharrock N, et al. The role of incision total hip arthroplasty. J Bone Joint Surg(Br), 2001;(83):213～217.
[12] Schofield SF.Minimally invasive surgery forhip replacement. ANZ J Surg, 2004;(74):287～288.
[13]金大地.关于微创人工全髋关节置换术的若干问题[J].中华外科杂志,2006;(44):509～511.
[14] Benin KC,RottingerH. Anterolateral mini-incision hip replacement surgery:amodified Watson-Jone.ClinOrthop, 2004;(429):248-255.
[15] Chimento CF,Pavone V,Sharrock N,et al. Minimally invasive total hip arthroplasty:aprospective randomized study. J Arthroplasty, 2005;(20):139～144.
[16] Nakamura S, Matsuda K, Arai N, et al. Mini-incision posterior approach for total hip arthroplasty. Int Orthop, 2004;(28):214～217.
[17] Dorr LD. Comparison of primary total hip replacements performed with a standard incision or a mini-incision. J Bone Joint Surg(Am),2005;(87):675～676.
[18] Sculco TP. Minimally invasive total hip arthroplasty: in the affirmative. J Arthroplasty, 2004;19(4 Suppl 1):78～80.
[19] Siguier T,Siguier M,Brumpt B. Mini-incision anterior approachdoes not increase dislocation rate: a study of 1037 total hip replacemenT. Clin Orthop Relat Res,2004;(426):164～173.
[20] Ogonda L,Wilson R, Archbold P, et al. A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes.aprospective, randomized, controlled trial. J Bone Joint Surg(Am), 2005;(87):701～710.
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