| 摘要: |
| 目的 了解将外科手术固定装置应用于直接前方入路全髋置换的临床疗效及其与常规直接前方入路全髋置换之间的区别。方法 选取2022年1月1日至6月30日在海军军医大学（第二军医大学）第二附属医院拟行直接前方入路全髋置换患者作为研究对象，并将1月1日至3月31日行直接前方入路全髋置换手术的患者纳入观察组，4月1日至6月30日行直接前方入路全髋置换手术的患者纳入对照组。观察组使用外科手术支架固定患肢，对照组采用常规手术方法。统计两组患者的手术时间、第一助手度过消毒铺巾学习曲线所需病例数、手术所需助手数量、髋臼假体前倾角、并发症发生率以及术前、术后6周时视觉模拟评分（VAS）和Harris评分。结果 共入组患者110例，观察组48例、对照组62例，两组患者一般资料及术前指标差异均无统计学意义（P均＞0.05）。与对照组相比，观察组术前消毒铺巾占用时间更短［（15.3±2.1）min vs （21.4±4.3）min，P＜0.05）］。观察组和对照组第一助手度过学习曲线所需的病例数分别为（4.7±0.6）例和（7.3±1.2）例，观察组第一助手度过学习曲线所需病例数小于对照组。与对照组相比，观察组所需助手更少（2位助手vs 3位助手）。观察组髋臼假体前倾角小于对照组，但两组间差异无统计学意义（18.4°±3.4°vs 21.3°±2.2°，P＞0.05）。两组患者术前和术后6周VAS评分、Harris评分差异均有统计学意义（P均＜0.05），两组间VAS评分、Harris评分差异无统计学意义（P均＞0.05）。结论 外科手术固定装置用于直接前方入路全髋置换可以缩短术前消毒铺巾时间，减少手术室的占用时间，对助手数量及培训时间要求较少，在手术操作过程中更容易掌握髋臼假体位置。 |
| 关键词: 全髋置换术 微创外科手术 假体位置 手术后并发症 手术时间 |
| DOI：10.16781/j.CN31-2187/R.20220467 |
| 投稿时间：2022-06-02修订日期：2022-12-30 |
| 基金项目:上海市申康医院发展中心临床科技创新项目(SHDC12019X14). |
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| Clinical study on surgical fixation device used in direct anterior approach total hip replacement |
| DING Zhe-ru,SHAO Jia-hua,CAO Jia,CHEN Yi,FU Pei-liang,WANG Bo* |
(Department of Orthopaedics, The Second Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200003, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the clinical outcomes of direct anterior approach (DAA) total hip replacement when using surgical fixation device and how it differs from the conventional DAA total hip replacement. Methods Patients who planned to undergo total hip replacement through DAA at The Second Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jan. 1 to Jun. 30, 2022 were selected. Patients who underwent total hip replacement through DAA from Jan. 1 to Mar. 31 were included in the observation group. Patients who underwent total hip replacement through DAA from Apr. 1 to Jun. 30 were included in the control group. The patients in the observation group were fixed with surgical fixation device, while the patients in the control group were fixed with conventional surgical methods. The operation time, the number of cases required by the first assistant to complete the learning curve of operation draping, the assistant number, the acetabular prosthesis anteversion angle, the incidence of complications, visual analog scale (VAS) and Harris scores before and 6 weeks after surgery were analyzed in the 2 groups. Results A total of 110 cases were included. Forty-eight patients were assigned to the observation group, while the others were assigned to the control group. No significant differences were found in the general information and preoperative indicators of the 2 groups (all P＞0.05). Compared with the control group, the time taken for preoperative sterilizing or draping in the observation group was shorter (［15.3±2.1］ min vs ［21.4±4.3］ min, P＜0.05). The numbers of cases required for the first assistant to complete the learning curve in the observation group and control group were 4.7±0.6 and 7.3±1.2, respectively. Fewer surgical assistants were required in the observation group than in the control group (2 vs 3). The acetabular prosthesis anteversion angle in the observation group was smaller than that in the control group, but with no significant difference (18.4°±3.4° vs 21.3°±2.2°,P＞0.05). There were significant differences in VAS scores and Harris scores of the 2 groups before and 6 weeks after surgery (all P＜0.05), while there were no significant differences in VAS scores or Harris scores between the 2 groups (all P＞0.05). Conclusion A surgical fixation device for DAA total hip replacement can shorten the preoperative sterilizing and draping time, reduce the duration in operating room, and requires less assistants and training time, making it easier to know the acetabular prosthesis position during the operation. |
| Key words: total hip replacement minimally invasive surgery prosthesis position postoperative complications operation time |
