Early pain relief and function after posterior minimally invasive and conventional total hip arthroplasty - A prospective, randomized, blinded study
Early pain relief and function after posterior minimally invasive and conventional total hip arthroplasty - A prospective, randomized, blinded study
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DOI：
10.2106/jbjs.f.00940
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发表时间：
2007-06-01
影响因子：
5.3
通讯作者：
Sirianni, Leigh Ellen
中科院分区：
文献类型：
--
作者：
Dorr, Lawrence D.;Maheshwari, Aditya V.;Sirianni, Leigh Ellen
背景资料：与传统全髋关节置换术相比，很少有前瞻性随机研究证明微创全髋关节置换术的益处。我们假设，在疼痛缓解和功能恢复方面，后路小切口治疗的患者比后路长切口治疗的患者效果更好，术后第二天即可出院。方法：231例合格患者中有60例接受了随机分组（每组30例）分别采用后路小切口（10 2 cm）和传统长切口（2 0 2 cm）行全髋关节置换术。在完成全髋关节置换术后，小切口组将皮肤切口延长至20 cm。根据患者自我确定的疼痛评分、疼痛药物需求、辅助步态装置需求和出院时间对患者进行评估。步态分析提供了客观的功能assessment.Results：平均住院时间为63.2 +/- 13.3小时的小切口组和73.6 +/- 23.5小时的长切口组（p = 0.04）。术后第二天出院的小切口患者更多（p = 0.003），出院时仅使用单一辅助器械的患者更多（p = 0.005）。根据0 - 10分的口头模拟量表评分，小切口患者术后每天疼痛较轻，出院时疼痛评分显著较低（平均2.2 ± 1.0分，而长切口组为3.1 ± 0.9分; p = 0.002）。出院后，有两组patients.Conclusions之间的疼痛或功能的临床差异：与传统的全髋关节置换术通过后方切口进行，后方微创全髋关节置换术导致更好的早期疼痛控制，早日出院回家，并减少使用辅助设备。随后在6周和3个月的评估显示两组的临床结果相当。证据等级：治疗I级。证据等级的完整描述见作者说明。
Background: Few prospective randomized studies have demonstrated benefits of minimally invasive total hip arthroplasty when compared with conventional total hip arthroplasty. We hypothesized that patients treated with a posterior mini-incision would have better results than those treated with a posterior long incision with regard to the achievement of established goals for pain relief and functional recovery permitting hospital discharge by the second postoperative day.Methods: Sixty of 231 eligible patients were randomized (with thirty in each group) to have a total hip arthroplasty performed through either a posterior mini-incision (10 2 cm) or a traditional long incision (20 2 cm). After completion of the total hip arthroplasty, the mini-incision group underwent extension of the skin incision to 20 cm. Patients were evaluated on the basis of self-determined pain scores, requirements for pain medicine, need for assistive gait devices, and time until discharge. Gait analysis provided objective functional assessment.Results: The average hospital stay was 63.2 +/- 13.3 hours in the mini-incision group and 73.6 +/- 23.5 hours in the long-incision group (p = 0.04). More patients with a mini-incision were discharged by the second postoperative day (p = 0.003) and more were using just a single assistive device at the time of discharge (p = 0.005). As scored on a verbal analog scale of 0 to 10 points, patients with a mini-incision had less pain on each postoperative day and the pain score remained significantly lower at the time of discharge (mean, 2.2 +/- 1.0 points compared with 3.1 +/- 0.9 points in the long-incision group; p = 0.002). After hospital discharge, there were no clinical differences in pain or function between the two groups of patients.Conclusions: Compared with conventional total hip arthroplasty performed through a posterior incision, posterior minimally invasive total hip arthroplasty resulted in better early pain control, earlier discharge to home, and less use of assistive devices. Subsequent evaluations at six weeks and three months showed equivalency between the clinical results in the two groups.Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.