| 乔高山,顾英骏,朱成栋,等.经皮辅助关节囊微创入路髋关节置换术的临床观察和学习体会.骨科,2020,11(5): 422-426. |
| 经皮辅助关节囊微创入路髋关节置换术的临床观察和学习体会 |
| Clinical observation and learning experience of supercapsular percutaneously-assisted joint capsule minimally invasive hip replacement |
| 投稿时间：2019-11-06 |
| DOI：10.3969/j.issn.1674-8573.2020.05.014 |
| 中文关键词: SuperPATH入路 关节成形术，置换，髋 微创 学习曲线 手术技巧 |
| 英文关键词: Supercapsular percutaneously-assisted total hip Arthroplasty, replacement, hip Minimal surgery Learning curves Surgical techniques |
| 基金项目:扬州市“十三五”科教强卫专项经费资助项目（ZDRC201834） |
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| 中文摘要: |
| 目的 探讨经皮辅助关节囊（SuperPATH）微创入路髋关节置换术的临床观察和学习体会。方法 回顾性分析2015年11月至2017年11月在我院行初次人工髋关节置换手术治疗髋关节疾患的病人205例，根据手术方式分为SuperPATH组（102例）和常规组（103例）。比较两组切口长度、手术时间、术中出血量、下地活动时间、住院时间、并发症，并用手术时间来评价学习曲线。结果 病人随访6~25个月，平均12.3个月。SuperPATH组的切口长度、术中出血量、下地活动时间、住院时间均优于常规组，差异均有统计学意义（P均＜0.05）。SuperPATH组出现脱位1例、假体周围骨折1例，常规组出现脱位3例、假体周围骨折4例、深静脉血栓1例、感染1例，两组的并发症发生率（1.96% vs. 8.74%）比较，差异有统计学意义（χ2=6.637，P＜0.001）。整体上看，两组手术时间无显著差异，但SuperPATH组手术在累积到30例后平均手术时间明显下降，累积到60例后依然持续下降。结论 SuperPATH微创入路髋关节置换创伤小、出血少、康复快、住院时间短、并发症发生率低，但SuperPATH有一定的学习曲线，手术医师应循序渐进，选择适当的适应证，熟练手术操作，不断提高手术技巧。 |
| 英文摘要: |
| Objective To explore the clinical observation and learning experience of supercapsular percutaneously-assisted total hip (SuperPATH) minimally invasive hip replacement. Methods The clinical data of 205 patients treated with initial total hip arthroplasty (THA) in our hospital from November 2015 to November 2017 were analyzed. These patients were divided into SuperPATH group (102 cases) and conventional group (103 cases). The incision length, operative time, blood loss, postoperative activity time, hospital stay, operative complications between two groups were compared. Learning curves were assessed by operative time. Results All of patients were followed up for 6-25 months. The incision length, blood loss, postoperative activity time, hospital stay in SuperPATH group were significantly reduced as compared with those in the conventional group (P＜0.05). There was 1 case of dislocation and 1 case of femoral fracture in SuperPATH group, and 3 cases of dislocation, 4 cases of femoral fracture, 1 case of peri-prosthetic joint infection and 1 case of deep venous thrombosis in conventional group. The incidence of complications between the two groups (1.96% vs. 8.74%) showed statistically significant difference (χ2=6.637, P＜0.001). There was no significant difference in operation time between the two groups. However, the average operation time in the SuperPATH group decreased significantly after cumulative 30 completed, and even kept a remarkable steady decline after cumulative 60 operations. Conclusion SuperPATH minimally invasive THA had the advantages of smaller wound, less blood loss, faster recovery, shorter hospital stay and lower complication rate, but it has certain learning curves. Surgeons should learn step by step, choosing appropriate indications to practice to continuously improve surgical techniques. |
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