CFP假体在后外侧微创入路全髋关节置换术中的应用

doi:10.3877/cma.j.issn.2096-0263.2019.006

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。

关键词: 微创手术, 关节成形术，置换，髋, CFP

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.

Key words: Minimally invasive surgical procedures, Arthroplasty, replacement, hip, CFP

图17~18 女性，34岁，右侧股骨头坏死，术前、术后骨盆正位

表1 46例全髋关节置换患者术前及术后不同时间点髋关节功能评分（分，±s）

时间	Harris评分	Barthel指数
术前	52.8±15.9	87.6±15.8
术后1 d	35.5±7.7^**	34.1±8.2^**
术后4 d	63.8±15.2^**	68.7±9.6^**
术后7 d	74.1±8.5^*	76.3±6.6^**
术后1个月	80.0±4.7^*	84.6±6.9^**
术后3个月	88.9±5.1^**	90.9±6.9^**
术后6个月	92.5±4.9^*	95.7±6.1^**
末次随访	93.3±4.7^*	95.9±6.7^*
F值	112.5	142.0
P值	<0.01	<0.01

表1 46例全髋关节置换患者术前及术后不同时间点髋关节功能评分（分，±s）

时间	Harris评分	Barthel指数
术前	52.8±15.9	87.6±15.8
术后1 d	35.5±7.7^**	34.1±8.2^**
术后4 d	63.8±15.2^**	68.7±9.6^**
术后7 d	74.1±8.5^*	76.3±6.6^**
术后1个月	80.0±4.7^*	84.6±6.9^**
术后3个月	88.9±5.1^**	90.9±6.9^**
术后6个月	92.5±4.9^*	95.7±6.1^**
末次随访	93.3±4.7^*	95.9±6.7^*
F值	112.5	142.0
P值	<0.01	<0.01

表2 46例VAS疼痛评分（分，±s）

时间	VAS评分
术前	6.6±1.5
术后1 d	4.9±1.2^**
术后4 d	3.5±1.0^**
术后7 d	2.4±0.8^*
术后1月	1.6±0.6^*
术后3月	1.1±0.6^**
术后6月	0.6±0.5^*
末次随访	0.6±1.3
F值	160.8
P值	<0.01

表2 46例VAS疼痛评分（分，±s）

时间	VAS评分
术前	6.6±1.5
术后1 d	4.9±1.2^**
术后4 d	3.5±1.0^**
术后7 d	2.4±0.8^*
术后1月	1.6±0.6^*
术后3月	1.1±0.6^**
术后6月	0.6±0.5^*
末次随访	0.6±1.3
F值	160.8
P值	<0.01

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Application of CFP prosthesis in posterior lateral minimally invasive total hip arthroplasty

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Application of CFP prosthesis in posterior lateral minimally invasive total hip arthroplasty