目的 探讨前路经皮辅助上方关节囊入路(Anterior SuperPATH)行人工全髋关节置换术(THA)对髋臼假体位置及早期髋关节功能的影响.方法 回顾性分析2019年11月至2022年6月在我院行THA的75例病人的临床资料,根据手术入路不同分为两组,38例采用前路经皮辅助上方关节囊入路的病人纳入前路通道组,37例采用传统后外侧入路的病人纳入后外侧组.记录并比较两组手术时间、术中出血量、术后卧床时间、住院时间、术后24h疼痛视觉模拟量表(VAS)评分,以及术后1周、1个月的髋关节Harris评分.术后拍摄骨盆正位X线片,测量髋臼假体的外展角与前倾角,并与Lewinnek安全区(髋臼外展角40°±10°、髋臼前倾角15°±10°)进行比较,评估放置髋臼假体的准确性.结果 病人随访8～21个月,平均为12.1个月.所有病人术后6个月均未见脱位.前路通道组手术时间长于后外侧组,手术出血量少于后外侧组,术后卧床时间与住院时间短于后外侧组,术后24h的VAS评分低于后外侧组,术后1周、1个月的髋关节Harris评分高于后外侧组,两组比较,差异均有统计学意义(P＜0.05).前路通道组的外展角和前倾角分别为42.78°±4.98°、15.29°±4.97°,二者均在安全区域的比例为84.2%(32/38);后外侧组的外展角和前倾角分别为41.49°±5.50°、13.58°±4.74°,二者均在安全区域的比例为83.8%(31/37);两组间比较,差异均无统计学意义(P＞0.05).结论 采用前路经皮辅助上方关节囊入路和后外侧入路行THA,髋臼假体位置无明显差异.虽然前路经皮辅助上方关节囊入路手术时间更长,但能明显减少手术出血,缓解手术疼痛,缩短住院时间,加速康复.

目的 探讨3D打印模型辅助微创手术治疗AO/OTA-43C型胫骨远端骨折的早期疗效.方法 回顾性分析2014年1月至2018年6月本科收治的AO/OTA-43C型胫骨远端骨折56例,术前3D打印模型辅助微创经皮钢板技术(3D打印微创手术组)24例,其中男14例,女10例;左侧8例,右侧16例;年龄为45～68岁,平均(54.8±5.7)岁;按AO/OTA分型:43C1型5例,43C2型15例,43C3型4例.采用常规切开复位内固定技术(ORIF组)32例,其中男17例,女15例;左侧12例,右侧20例;年龄54～71岁,平均(58.7±5.3)岁;按AO/OTA分型:43C1型7例,43C2型18例,43C3型7例.比较两组在手术切口长度、手术时间等指标和并发症方面情况.结果 所有患者随访10～18个月,平均随访(13.6±2.5)个月.在手术切口长度、术中出血量、平均住院时间、术中透视次数、Johner-Wruhs功能评分优良率、骨折愈合时间等方面,3D打印组较ORIF组有明显优势,差异均有统计学意义(P＜0.05).两组均有1例并发创伤性关节炎,ORIF组1例并发切口感染.结论 3D打印辅助微创接骨板技术治疗AO/OTA-43C型胫骨远端骨折创伤小、出血少、X线暴露少,早期临床疗效满意.

目的:探讨经皮辅助关节囊微创(supercapsalar percutaneously assisted total hip,SuperPATH)入路全髋关节置换术(total hip arthroplasty,THA)的临床疗效、学习曲线.方法:选择102例髋关节疾病患者采用SuperPATH-THA治疗,记录手术情况、术后并发症、臼杯外展角和前倾角、术后24 h疼痛视觉模拟量表(visual analogue scale,VAS)评分及术后第7天Harris髋关节功能评分,通过分析前后手术病例的相关指标,评价该术式的学习曲线.结果:患者均获得随访,时间6～25个月,手术时间、术中出血量、住院时间在完成36例SuperPATH-THA后明显下降,趋于稳定.以36例为界,分为学习期(36髋)和稳定期(66髋).SuperPATH-THA稳定期的手术时间、术中出血量、首次下地时间、住院时间明显小于学习期,差异有统计学意义(P均<0.01).SuperPATH-THA学习期与稳定期在手术切口长度、臼杯外展角和前倾角、术后24 h VAS评分及术后第7天髋关节功能Harris评分方面的差异均无统计学意义(P>0.05).学习期内发生假体脱位1例,假体周围骨折1例.结论:SuperPATH-THA具有符合微创和快速康复理念、住院时间短、并发症发生率低等优势;SuperPATH-THA学习曲线为36例左右,度过学习曲线后,能为患者提供更好的手术疗效.

目的 探讨前路经皮辅助关节囊上方入路(Anterior SuperPATH)全髋关节置换术(THA)的手术技术和早期疗效.方法 回顾性分析2019年11月至2020年10月在我院行THA的48例病人的临床资料,根据手术入路不同分为两组,23例采用前路经皮辅助关节囊上方入路者纳入Anterior Super-PATH组,25例采用经皮辅助通道上方关节囊入路者纳入SuperPATH组,记录并比较两组围手术期相关指标、髋臼杯位置、术后24 h疼痛视觉模拟量表(visual analogue scale,VAS)评分、术后6个月Harris评分、并发症发生情况.结果 病人随访6～25个月,平均为12.3个月.两组手术时间、术中出血量、下床活动时间、术后24 h VAS评分、髋臼假体外展角、术后6个月Harris评分的差异无统计学意义(P>0.05).Anterior SuperPATH组髋臼前倾角位置比SuperPATH组更佳,差异有统计学意义(P<0.05).Anterior SuperPATH组大腿外侧麻木1例,SuperPATH组脱位1例、股骨大转子骨折2例.结论 与SuperPATH组比较,Anterior SuperPATH组显示出相似的近期效果.前路经皮通道能够避免股骨的遮挡,直视化下操作,同轴髋臼侧处理,降低手术并发症,提高髋臼假体放置的精准性.

目的 探讨经皮辅助关节囊(SuperPATH)微创入路髋关节置换术的临床观察和学习体会.方法 回顾性分析2015年11月至2017年11月在我院行初次人工髋关节置换手术治疗髋关节疾患的病人205例,根据手术方式分为SuperPATH组(102例)和常规组(103例).比较两组切口长度、手术时间、术中出血量、下地活动时间、住院时间、并发症,并用手术时间来评价学习曲线.结果 病人随访6～25个月,平均12.3个月.SuperPATH组的切口长度、术中出血量、下地活动时间、住院时间均优于常规组,差异均有统计学意义(P均<0.05).SuperPATH组出现脱位1例、假体周围骨折1例,常规组出现脱位3例、假体周围骨折4例、深静脉血栓1例、感染1例,两组的并发症发生率(1.96％vs.8.74％)比较,差异有统计学意义(χ2=6.637,P<0.001).整体上看,两组手术时间无显著差异,但SuperPATH组手术在累积到30例后平均手术时间明显下降,累积到60例后依然持续下降.结论 SuperPATH微创入路髋关节置换创伤小、出血少、康复快、住院时间短、并发症发生率低,但SuperPATH有一定的学习曲线,手术医师应循序渐进,选择适当的适应证,熟练手术操作,不断提高手术技巧.

目的 探讨SuperPATH微创入路人工股骨头置换术治疗高龄股骨颈骨折的早期疗效.方法 回顾性分析2015年10月～2017年6月期间采用SuperPATH微创入路人工股骨头置换术治疗51例高龄股骨颈骨折患者资料.其中,男20例,女31例;左髋19例,右髋32例;平均年龄为(75.6±9.7)岁.观察切口长度、手术时间及并发症等方面情况.评价术前、术后3d、6个月及12个月患髋Harris评分.结果 51例患者均获12～18个月随访.手术切口长度(6.5±1.7) cm,手术时间(40.9±2.6) min,住院时间(6.5±1.8)d,术中出血量(138.7±30.5) mL,下地行走时间(1.6±0.8)d.随访期间无切口感染、DVT、关节脱位等严重并发症.术后3d与术前患侧髋关节Harris评分[(67.3±6.3)分,(12.1±4.3)分]比较;术后6个月与术后3d患侧髋关节Harris评分[(84.7±4.5)分,(67.3±6.3)分]比较,差异均有统计学意义(P＜0.05).结论 SuperPATH微创入路人工股骨头置换术治疗高龄股骨颈骨折能有效改善髋关节功能,早期疗效明显;不仅具有创伤小、疼痛轻、患者满意度高等优点,还能降低术后关节脱位等风险.

Objective To explore the clinical application of preoperative 3D printing design combined with minimally invasive percutaneous plate internal fixation ( MIPPO) in the treatment of middle and lower tibiofibular fractures. Methods Retrospective analysis of clinical data of 110 patients with fractures of the middle and lower tibia in the Department of Orthopaedics, Yizheng People’s Hospital from January 2012 to June 2017. Preoperative 3D printing design combined with minimally invasive percutaneous plate internal fixation technology (3D printing group) was performed in 48 patients, including 28 males and 20 females,17 on the left and 31on the right,aged from 19 to 68 (42.5 ± 5.7) years.According to AO/OTA classification,there were 11 patients of type A, 19 patients of type B, and 18 patients of type C. Open reduction and internal fixation (ORIF group) was used in 62 patients, including 34 males and 28 females;25 on the left and 37 on the right. aged from 21 to 72 ( 44.7 ± 7.5 ) years. According to AO/OTA classification, there were 16 patients of type A, 22 patients of type B, and 24 patients of type C. The operation data such as incision length, the amount of bleeding, the X-ray exposure times, the hospitalization time, the fracture healing time, excellent and good rate of ankle joint function and incidence of complications were recorded and analyzed. Results All patients were followed up for 12.0 to 18.0 ( 13.6 ± 2.5 ) months. The length of the incision (the cumulative length of the tibia) in the 3D print group and the ORIF group were (7.57 ± 1.63) cm and (12.7 ± 2.73) cm.The amount of bleeding were(45.7 ± 10.5) mL and (120.3 ± 17.9) mL, respectively.The hospitalization time of the two groups were (10.3 ± 3.17) d and (13.9 ± 3.43) d, respectively. The X-ray exposure times were (3.07 ± 2.13) times and (1.46 ± 1.85) times, respectively. The fracture healing time were ( 4.2 ± 2.65 ) months and ( 5.9 ± 2.32 ) months, respectively. The functional scores of the ankle joint Johner-Wruhs in the 3D print group and the ORIF group were excellent in 27 patients, good in 17 patients, fair in 4 patients, and excellent in 25 patients, good in 24 patients, fair in 11 patients, and poor in 2 patients, the difference was statistically significant ( Z =2.555, P <0.05 ); the complication rates were 0 ( 0/48) and 4.8% ( 3/62 ), respectively, and the difference was not statistically significant (χ2 =0.912, P>0.05). Conclusions Preoperative 3D printing design combined with minimally invasive percutaneous plate internal fixation for the treatment of the middle and lower tibiofibular fractures can fully evaluated fracture before surgery.It has minimal traumatic features such as less trauma and less bleeding, and can promote fracture healing and improve ankle function.