Bikini切口直接前入路全髋关节置换术的短期疗效

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目的:对比比基尼(Bikini)切口与传统切口在直接前入路(direct anterior arthroplasty, DAA)全髋关节置换术(total hip arthroplasty,THA)中应用的短期临床疗效,为临床DAA入路切口的选择提供指导依据。方法:收集2019年1月至11月86例行DAA入路THA患者的临床资料,男13例,女73例,年龄(67.5±11.8)岁(范围:42~90岁)。分别采用Bikini切口和传统切口进行DAA入路THA,每组均纳入43例患者进行回顾性病例对照研究:Bikini切口组,男5例,女38例;年龄(69.7±10.8)岁(范围:51~90岁);随访时间5.7个月(3.0~8.5个月);传统切口组,男8例,女35例;年龄(66.1±10.6)岁(范围:42~90岁);随访时间6.5个月(3.0~10.0个月)。比较两组手术时间、切口长度、瘢痕面积、感染、股外侧皮神经(lateral femoral cutaneous nerve,LFCN)神经损害和髋关节功能改善(Harris评分)情况;切口瘢痕采用患者瘢痕评估量表和温哥华瘢痕评估量表进行评估。结果:43例Bikini切口组和43例传统切口组在年龄、性别、体重指数和疾病分布上差异无统计学意义。两组患者在手术时间、术中出血量、切口长度、术后疼痛用药和髋关节Harris评分方面比较差异均无统计学意义,所有患者均未发生切口感染。在LFCN神经损害表现方面,Bikini组明显低于传统切口组(11.6% n vs 32.6%,n t=7.858,n P<0.05),差异有统计学意义。Bikini切口的瘢痕面积(1.0±0.4)cmn 2明显小于传统切口组的(16.5±28.7)cmn 2,差异有统计学意义(n t=9.734,n P<0.05)。患者瘢痕评估量表和温哥华瘢痕评估量表评分中,Bikini组分别为(8.2±3.2)分和(2.4±1.8)分,传统切口组分别为(17.0±5.8)分和(4.2±3.0)分,Bikini组明显优于传统切口组,差异均有统计学意义(n P<0.05)。n 结论:Bikini切口较传统切口具有更低的LFCN神经损害表现发生率,切口瘢痕明显较小,视觉美学效果更好,有很好的临床应用价值。“,”Objective:To compared theclinic effectiveness ofBikini incision with that of traditional incisionbased on a short-term following and provide a suggesting reference for surgeons.Methods:The data of patients who accepted total hip arthroplasty (THA) through direct anterior approach (DAA) from January to November in 2019 were collected, male 13 and female 73, age 67.5±11.8 years (42-90 years). Forty-three patients were recruited to analyzeas one retrospective study in each group. Bikini incision: male 5 and female 38; age 69.7±10.8 years (51-90 years), following up 5.7 months (3.0-8.5 months). Traditional incision: male 8 and female 35; age 66.1±10.6 years (42-90 years), following up 6.5 months (3.0-10.0 months). The length area of incision, duration of operation, intraoperative blood loss, the rate of infection, lateral femoral cutaneous nerve (LFCN) deficits, and the Harris score were analyzed between those two groups. The scars were evaluated according toPatients Scar Assessment Scale and Vancouver Scar Scale.Results:There were no significant difference in age, sex, BMI and diseases distribution between Bikini and traditional incision group. The length of incision, duration of operation, analgesic drugs dosage and hip Harris score wereanalysed no significant difference between those two groups. No patients in those twogroupssuffered from infection of incision. As to LFCN deficits, Bikini group had lower than traditional group (11.6% n vs 32.6%, n P=0.019). The scar area of Bikini group 1.0±0.4 cmn 2 wasmeasured smaller rate than that of traditional group 16.5±28.7 cmn 2. As to the Patients Scar Assessment Scale and Vancouver Scar Scale, Bikini group was 8.2±3.2 and 2.4±1.8, which was better than traditional group which was 17.0±5.8 and 4.2±3.0.n Conclusion:Compared to traditional incision, Bikini incision was evaluated having significant lower rate of LFCN deficits and smaller scar,good cosmetic appearance and clinical application value.
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