侧卧位直接前方入路全髋关节置换早期临床疗效

发布时间：2018-02-12 17:34

本文关键词： 直接前方入路全髋关节置换侧卧位并发症学习曲线　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的直接前方入路(direct anterior approach,DAA)全髋关节置换通过神经界面和肌肉间隙显露髋关节,是一真正的微创手术入路。然而,侧卧位DAA全髋关节置换文献鲜见报道,本研究目的在于评价侧卧位DAA的技术可行性和早期临床效果、影像学结果和手术并发症。方法本研究是一项前瞻性、无对照、评估者盲法的单中心观察性试验。2014年7月1日至2014年12月31日,我院骨科共招募248人(295髋)需要行初次全髋关节置换术治疗的患者,依据纳入标准和排除标准共126髋完成初次侧卧位直接前方入路全髋关节置换术。经过术后12个月随访,117髋获得完整的临床和影像学随访资料,评估侧卧位直接前方入路全髋关节置换术的早期随访结果。结果平均手术时间72分钟(59-160分钟),平均术中出血329ml(185-655ml)。平均髋关节Harris评分术后1个月为82.1(74-90)分,术后3个月为86.0(79-95)分,术后12个月为88.6(80-96)分,均较术前53.2(44-65)分明显改善(p0.001)。髋臼平均前倾角为16.5°±4.9°,外展角为43.3°±3.5°。98髋(83.8%)髋臼假体的前倾角和外展角位于“安全范围”内。双下肢长度差异由术前11mm(0-22mm)纠正为术后3m(-5-15mm)(Wilcoxon符号秩和检验,Z=-8.27,p0.001)。43髋(36.8%)发生股外侧皮神经损伤,1髋发生术中股骨近端骨折,2髋术后早期出现髋关节脱位,3髋髋臼杯未完全打入臼窝。所有病例术后1年随访未发生术后假体周围骨折、无菌性假体松动。结论早期临床和影像学随访结果证实侧卧位直接入路全髋关节置换手术技术安全可行。当无特殊手术床或牵引床时,可考虑侧卧位直接前方入路替代平卧位直接前方入路,有利于直接前方入路的推广。
[Abstract]:Objective Direct anterior approach (anterior approachDAA) is a true minimally invasive approach for total hip replacement through nerve interface and muscle space. However, the literature on DAA total hip replacement in lateral position is rarely reported. The purpose of this study was to evaluate the technical feasibility, early clinical effect, imaging results and surgical complications of lateral lying DAA. From July 1st 2014 to December 31st 2014, a total of 248 patients were recruited in our orthopedic department to receive initial total hip arthroplasty. According to the inclusive and exclusion criteria, 126 hips underwent direct anterior approach total hip arthroplasty in the first lateral position. After 12 months follow-up, 117 hips were followed up with complete clinical and imaging data. To evaluate the early follow-up results of total hip arthroplasty with direct anterior approach in lateral position. Results the average operative time was 72 minutes, the mean operative time was 59-160 minutes, the average intraoperative bleeding was 329ml / 185-655ml / L, the average Harris score was 82.1 / 74-90 / month and 86.079-95 / 86.079-95, respectively. At 12 months after operation, the score was 88.6 / 80-96). The average acetabular anteversion angle was 16.5 掳卤4.9 掳, and the abduction angle was 43.3 掳卤3.5 掳.98 hip axis angle was 83.8 掳) the anteversion and abduction angle of acetabular prosthesis were in "safe range". The difference of lower extremity length was corrected from 11mm to 22mm before operation to 3mm-5-15mm mark rank and Wilcoxon sign rank. The fracture of proximal femur occurred in 1 hip, 2 hips had dislocation of hip joint in the early stage after operation, 3 acetabular cup had not completely penetrated into the acetabular fossa. All the cases were followed up one year after operation, no periprosthetic fracture occurred. Conclusion early clinical and imaging follow-up results show that direct approach to total hip arthroplasty in lateral position is safe and feasible when there is no special bed or traction bed. The direct anterior approach in lateral position may be considered instead of the direct anterior approach in supine position, which is beneficial to the popularization of direct anterior approach.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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