直接前入路和后外侧保留梨状肌入路全髋关节置换术的疗效对比

发布时间：2018-02-04 01:43

  本文关键词： 关节成形术 置换 髋 直接前入路 微创外科手术 后外侧保留梨状肌入路　出处：《北京大学学报(医学版)》2017年02期 　论文类型：期刊论文

【摘要】：目的:前瞻性比较直接前入路(direct anterior approach,DAA)和后外侧保留梨状肌入路(posterolateral piriformis-sparing approach,Mis-PLA)全髋关节置换的临床疗效。方法:选自福建省立医院骨科2015年3月至2016年2月收入院需行全髋关节置换术的患者,随机分为DAA和Mis-PLA两组。DAA组(43例45髋):男27例27髋,女16例18髋,平均年龄(57.4±7.3)岁,术前Harris评分(41.4±8.7)分,体重指数(body mass index,BMI)为(24.3±2.2)kg/m2;Mis-PLA组(39例42髋):男25例26髋,女14例16髋,平均年龄(59.2±7.3)岁,术前Harris评分(39.6±8.4)分,BMI(24.7±2.5)kg/m2。分别对两组的切口长度、手术时间、术中出血量、术后Harris评分、关节功能恢复进行对比评估。结果:(1)两组患者手术切口均Ⅰ/甲级愈合。手术切口长度:DAA组(9.2±0.7)cm,Mis-PLA组(9.5±0.6)cm,两者间差异无统计学意义(P=0.053);手术时间:DAA组(74.3±10.1)min,Mis-PLA组(37.5±4.3)min,两者间差异有统计学意义(P0.01);出血量:DAA组(229.6±79.2)m L,Mis-PLA组(215.7±56.0)m L,两者之间差异无统计学意义(P=0.366)。(2)随访时间6~12个月,术后6周Harris评分:DAA组(85.5±4.1)分,Mis-PLA组(79.0±4.4)分,两组间差异有统计学意义(P0.01)。术后6个月Harris评分,DAA组(94.3±2.7)分,Mis-PLA组(95.2±1.9)分,两组间差异无统计学意义(P=0.125)。术后6周髋关节功能评估,DAA组和Mis-PLA组在直线步行速度上差异没有统计学意义(P=0.298),Mis-PLA组上、下楼梯速度优于DAA组(P=0.047);在转弯速度、坐下、穿袜时,DAA组优于Mis-PLA组(P0.01,P=0.016,P0.01)。结论:直接前入路和后外侧保留梨状肌入路的微创全髋关节置换术都能获得满意的临床疗效,后外侧入路的优势在于手术时间短、学习曲线短,直接前入路的主要优势在于术后早期没有体位限制的要求及髋关节功能恢复的更快。
[Abstract]:Objective: to prospectively compare direct anterior approach with direct anterior approach. DAA) and posterolateral piriformis-sparing approach reserved for the posterolateral piriformis approach. Clinical effect of Mis-PLA total hip replacement methods: from March 2015 to February 2016, the orthopaedic department of Fujian Provincial Hospital received total hip replacement. DAA and Mis-PLA groups were randomly divided into two groups: 27 males (27 hips) and 16 females (18 hips), with an average age of 57.4 卤7.3 years. Preoperative Harris score (41.4 卤8.7) and body mass index (BMI) were 24.3 卤2.2 kg / m ~ (2); In Mis-PLA group, there were 39 cases (26 hips), 25 males (26 hips) and 14 females (16 hips), with an average age of 59.2 卤7.3 years. The preoperative Harris score (39.6 卤8.4) was 24.7 卤2.5 kg / m2. The incision length, operative time and intraoperative bleeding were measured. The postoperative Harris score and the recovery of joint function were compared and evaluated. Results the operative incision in both groups was 鈪，

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