Comparison Of The Curative Effect Of Two Minimally Invasive Total Hip Arthroplasty

OBJECTIVE: Hip disease is one of the most common diseases in Department of orthopedics.It is commonly seen in elderly patients.In recent years,with the increasing number of elderly patients in China,the incidence of hip disease is increasing.So far,total hip arthroplasty(THA)is the most suitable treatment for advanced hip disease,but traditional surgery has many disadvantages,such as large trauma,slow recovery and postoperative complications.And now more and more people attach importance to minimally invasive treatment.Therefore,minimally invasive total hip arthroplasty(MIS-THA)has been formally proposed.And it quickly developed in the clinic,bcome one of the latest representatives of THA.At present,there are many ways of surgical approach to MIS-THA.But its development time is relatively short.There is no unified provision about what type of surgical approach should be chosen.The clinical effect of various surgical approaches should be further discussed.This study is to compare the most frequently used minimally invasive direct approach to the Posterolateral small incision approach at the present stage.The results of the two surgical approaches were compared by data analysis.METHODS: A retrospective analysis of 73 cases of unilateral MIS-THA hospitalization in the Second Affiliated Hospital of Dalian Medical University from September 2015 to August 2017 was reviewed.According to the different surgical approach,the anterior approach group(anterior approach group)and the posterolateral small incision group(posterolateral group)were divided into the anterior approach group(anterior approach group)and the posterolateral small incision approach group.Among them,38 cases of anterior group,20 males and 18 females.There were 14 patients with femoral neck fracture,11 patients with femoral head necrosis and 13 patients with osteoarthritis of the hip joint.The average age is 69.55 years old.The preoperative Harris function score was 58.34±4.66 points.There were 35 cases in the posterolateral group,18 males and 17 females.12 patients were hospitalized for femoral neck fractures,10 patients had Huan Yougu bone necrosis and 13 patients had hip osteoarthritis,with an average age of 67.83 years old.The preoperative Harris function score was 56.71±3.95 points.The operation time,length of the incision,the time of hospitalization,the amount of bleeding in the operation,and the flow rate after the operation were then counted.The rate of blood transfusion was calculated(the number of patients who needed blood transfusion during or after the operation,and then calculated the percentage of the total number of the groups in the group).The Harris functional score of the patients at sixth months after operation was evaluated by the Harris hip function scale,and the excellent and good rate was evaluated according to the scores obtained.The number of patients with or without complications after surgery and the incidence of this complication were recorded.The results were as follows: the operative time in the anterior group was 105.13±6.52 min,the incision length was9.71±0.47 cm,the operative blood loss was 307.24±45.26 ml,Postoperative flow rate was 141.39±21.01 ml,the hospitalization time was 8.24±0.54 days.3 patients needed blood transfusion,and the transfusion rate was 7.89%.6 months after operation,the Harris function score was 87.24±3.37 points,the excellent and good rate was 86.84%,1cases had posterior dislocation of hip joint,1 cases had femoral fractures,8 cases had lateral femoral cutaneous nerve injury.The operative time in the posterolateral group was 99.86±5.12 min,the incision length was 10.10±0.41 cm,the operative blood loss was 290.29±33.81 ml,Postoperative flow rate was 136.86±16.32 ml,and the hospitalization time was 10.60±0.81 days.Among them,2 patients needed blood transfusion,the rate of transfusion was 5.71%,6 months after operation,the Harris function score was 84.34±4.28 points,the excellent and good rate was 82.86%,2patients had posterior dislocation of hip joint after operation.RESULTS:1.There was no significant difference in the operation time and the length of the incision between the anterior and the posterolateral group(P>0.05).2.There was no significant difference in the amount of bleeding,the flow rate and the rate of blood transfusion in the two groups(P>0.05).At the time of hospitalization,the anterior group was superior to the posterolateral group(P<0.05).3.The Harris hip function score of the anterior group was significantly higher than that of the preoperative group at 6 months after operation(P<0.05),and the Harris score of the hip function of the posterolateral group was significantly higher than that of the preoperative group at 6 months after operation(P<0.05).There was no significant difference in the Harris hip joint function score and the good rate between the two groups at 6 months after operation(P>0.05).4.In the anterior group,there were 1 cases of posterior dislocation of the hip,1cases of femoral fractures,8 cases of lateral femoral cutaneous nerve injury,and 2 cases of posterior lateral dislocation.CONCLUSION:The two was a minimally invasive surgical approach significantly improved after operation of hip joint function of patients,has good clinical effect,has the advantages of minimally invasive direct anterior approach is convenient for management of respiratory tract in patients with intraoperative and early postoperative patients more convenient,faster recovery,without limitation,cross your legs bent and lateral small incision into the forbidden road the action.The advantage of the posterolateral small incision approach is that the operation of the femur is good during the operation,the operation is convenient,the learning curve is shorter,and the Department of orthopedics doctor is easier to master.