背景:微创全髋关节置换较之于传统全髋关节置换,其具有置换切口小、失血量少、置换后疼痛轻脱位发生率低、置换后康复期短等优点,但是置换后应激及体内代谢相关的血清学指标的变化尚缺乏系统的报道.目的:观察微创与常规全髋关节置换治疗前后相关细胞因子水平的变化及与临床疗效的关系.方法:纳入178例于2015年1月至2017年1月在西南医科大学附属医院骨与关节外科行单侧全髋关节置换的患者,随机分为观察组(n=89)与对照组(n=89).对照组接受传统标准后外侧入路行全髋关节置换;观察组接受前外侧入路微创全髋关节置换.收集记录2组患者关节置换情况相关指标;于置换前、置换后1,3, 6及12个月进行髋关节Harris评分;置换前、置换后1,3 d采用ELISA法检测血清白细胞介素1,6,10、肿瘤坏死因子α以及降钙素原水平.结果与结论:①所有患者顺利完成关节置换并获得随访, 随访时间为12个月;②两组患者的年龄、性别、体质量指数及关节置换部位无明显差异(P > 0.05);③观察组手术时间、住院时间及关节置换切口长度均显著短于对照组,关节置换中失血量、输血量及置换后引流量均显著少于对照组(P < 0.05);④两组患者置换后各时间点髋关节Harris评分较置换前均有所上升,且观察组置换后1及3个月的Harris评分显著高于对照组(P < 0.05);⑤观察组置换后1及3 d的血清白细胞介素1,6,10、肿瘤坏死因子α以及降钙素原水平显著低于照组;⑥结果提示,微创全髋关节置换疗效优于常规全髋关节置换,且能显著降低相关细胞因子水平,更有利于患者下肢运动功能的快速恢复.%BACKGROUND: Compared with conventional total hip replacement, minimally invasive total hip replacement has some advantages, such as small incision, less blood loss, light pain, low incidence of dislocation, and short rehabilitation period. However, changes in post-displacement stress and in vivo metabolism-related serological indicators have not been systematically reported. OBJECTIVE: To observe cytokines and curative effect before and after minimally invasive total hip replacement and conventional total hip replacement. METHODS: We selected 178 patients who underwent unilateral total hip replacement in the Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University from January 2015 to January 2017. They were randomly divided into observation group (89 cases) and control group (89 cases). The control group was treated by total hip arthroplasty through the standard invasive posterolateral approach. The observation group was treated by total hip arthroplasty through the minimally invasive anterolateral approach. The related operation indexes were recorded in two groups. Harris score was analyzed preoperatively, 1, 3, 6 and 12 months after surgery. The serum levels of interleukin (IL)-1, IL-6, IL-10, tumor necrosis factor (TNF)-α and procalcitonin were measured by enzyme linked immunosorbent assay preoperatively, 1 and 3 days after surgery. RESULTS AND CONCLUSION: (1) All patients were followed up for 12 months. (2) Age, sex, body mass index and joint replacement site were not significantly different in both groups (P > 0.05). (3) The operation time, hospital stay and incision length in the observation group were shorter than those in the control group. The blood loss, blood transfusion, and postoperative drainage in the observation group were less than those in the control group (P < 0.05). (4) Harris Score increased at various time points after replacement in both groups. Harris score was significantly higher in the observation group than in the control group at 1 and 3 months after surgery (P < 0.05). (5) The serum levels of IL-1, IL-6, IL-10, TNF-α and procalcitonin in the observation group were significantly lower than in the control group 1 and 3 days after surgery. (6) These findings confirm that minimally invasive total hip arthroplasty has better curative effect than conventional total hip arthroplasty, and can reduce related cytokine levels, and is more conducive to the rapid recovery of lower extremity motor function.
展开▼
