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

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.
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.

[1]	朱洪宇, 曹越, 赵鑫洋, 周毅. 三孔全腔镜手术治疗中重度男性乳房发育症[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(03): 152-157.
[2]	丁莹莹, 宋恺, 金姬延, 田华. 机器人辅助膝髋关节置换术后精细化临床护理[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 553-557.
[3]	孔德铭, 刘铮, 李睿, 钱文伟, 王飞, 蔡道章, 柴伟. 人工智能辅助全髋关节置换三维术前规划准确性评价[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 431-438.
[4]	刘晓凡. 老年股骨头坏死髋关节置换术后康复应用多维度干预[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 314-319.
[5]	刘正宇, 刘春风, 王振. 改良后外侧入路半髋置换治疗股骨颈骨折的早期疗效[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 409-413.
[6]	钟向娣, 任婷婷, 任丽, 刘梦碟, 周娅颖, 游月梅, 张琳玲. 全髋关节置换护理的可视化分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(02): 256-263.
[7]	中华医学会器官移植学分会, 中国医师协会器官移植医师分会. 中国活体肝移植供者微创手术技术指南（2024版）[J/OL]. 中华普通外科学文献(电子版), 2024, 18(04): 241-252.
[8]	中华医学会器官移植学分会, 中国医师协会器官移植医师分会. 中国活体肝移植供者微创手术技术指南(2024年版)[J/OL]. 中华移植杂志(电子版), 2024, 18(02): 74-85.
[9]	曾纪晓, 梁子建. 单孔腹腔镜手术在儿童普通外科中的应用与展望[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(02): 65-69.
[10]	张宗明, 董家鸿, 何小东, 王秋生, 徐智, 刘立民, 张翀. 老年胆道外科热点问题的争议与思考[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 754-762.
[11]	曹文钰, 郭鹏, 李锦平. 微创手术及非手术方式治疗慢性硬膜下血肿的研究进展[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(05): 304-309.
[12]	李新宇, 梁建锋. 3D打印导板辅助颅内血肿穿刺引流手术[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(06): 382-384.
[13]	朱芮晴, 张荣贵, 冯秀雪, 张波, 刘圣圳, 柴宁莉, 令狐恩强. 基于倾向性评分匹配法的日间消化内镜超级微创手术治疗直肠神经内分泌肿瘤的疗效评价[J/OL]. 中华胃肠内镜电子杂志, 2024, 11(03): 166-170.
[14]	蔡朝蓓, 陈倩倩, 宁波, 李惠凯, 袁新普, 令狐恩强. 超级微创手术模式与器官切除模式下结直肠癌患者的生活质量和心理状态变化[J/OL]. 中华胃肠内镜电子杂志, 2024, 11(02): 81-87.
[15]	沈海锋, 吕方伊, 顾海华, 常志博, 陈盈, 王苹莉, 吴祖群, 邱福铭, 姚杰, 范军强. 局部进展期肺癌新辅助治疗后胸腔镜袖式肺叶切除术——浙江大学医学院附属第二医院2014—2023年56例回顾性分析[J/OL]. 中华胸部外科电子杂志, 2024, 11(03): 158-166.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

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

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

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