直接前路法与后路法在股骨头坏死全髋关节置换中的比较

发布时间：2018-05-02 20:49

本文选题：直接 + 前路　；参考：《大连医科大学》2017年硕士论文

【摘要】：背景:全髋关节置换术是目前股骨头坏死的主要治疗手段。就外科手术技术及内植物材料而言,全髋关节置换术经历了许多阶段。随着时间的推移,手术的各个方面均得到了改进,使病人和医生更加受益。目前全髋关节置换有多种手术方法,这些方法都有各自的优点和缺点。目前最常用的两种方法是直接前路或后路手术。为了找到最佳的手术方法,虽然有学者已经进行了许多研究,但目前学术界尚未达成共识。在本研究中,作者试图通过回顾本科室的相关手术资料对比研究直接前方入路和后外侧入路,寻找股骨头坏死全髋关节置换术的最佳手术入路。为了达到这个目的,作者对术前、术中及术后的指标进行测量、统计分析,并结合了术后并发症的研究。病人资料与研究方法:本研究在大连医科大学医院关节外科进行,针对的是2014年9月至2016年12月收治的,接受全髋关节置换术的股骨头坏死病人。我们共选取了78位患者,年龄范围在39岁到89岁之间。根据手术入路的不同,将78位患者分为两组:直接前入路组(DAA)和后外侧入路组(PA)。DAA组中包括35例患者,其中20名女性,15名男性,年龄范围在44岁至89岁之间。PA组包括43例患者,其中20名女性23名男性,年龄范围在39岁至81岁之间。比较和回顾研究主要基于以下参数:(1)一般资料:(a)年龄,(b)性别(c)体重指数(BMI);(2)术前参数:(a)Harris髋关节评分,HHS(术前)(b)血红蛋白指标(术前);(3)术中参数:(a)手术时长;(b)术中失血量;(4)术后参数(a)术后出血量(引流袋中的血量),(b)血红蛋白值的差异(术前和术后比较),(c)术后住院天数,(d)术后不同时间段的Harris髋关节评分(分别为2周,4周,6周,12周,6个月,1年),(e)术后的影像学并发症(移位和骨折)。数据采用SSPS软件22.0分析,进行描述性统计,应用t检验,皮尔森相关和重复测量方法。结果:直接前入路组(DAA)的平均年龄是59.83±9.473岁,后外侧入路组(PA)的平均年龄是55.74±9.781岁。年龄的差异(t=1.860,P=0.067)和性别差异(x2=0.873,P=0.350)无统计学意义。DAA组患者的平均体重指数(BMI)为24.978±3.002kg/m2(范围:19.03-30.86 kg/m2)。PA组患者的平均体重指数(BMI)为25.189±3.009 kg/m2(范围:18.67-31.25 kg/m2)。平均体重指数(BMI)的差异无统计学意义(t=-0.309,p=0.758).术前参数:术前DAA组Harris髋关节评分(HHS)是44.00±7.046,PA组的是44.70±10.232.该项结果无统计学意义上的差异(t=-0.342 p=0.733)。术前DAA组血红蛋白的平均值为13.157±1.398 g/d L,PA组的是13.714±1.509 g/d L.该项结果差异无统计学意义(t=-1.675,p=0.098).术中参数:DAA组手术平均耗时(81.86±13.778分钟)长于PA组(77.79±13.597分钟)。该项结果差异无统计学意义(t=1.306,p=0.196).DAA组术中平均失血量(275.71±129.689 m L)少于PA组(324.42±153.674 m L)。该项结果差异无统计学意义(t=-1.491,p=0.140).术后参数:DAA组术后住院时间(14.31±5.90天)短于PA组(15.12±7.13天)。该项结果差异无统计学意义(t=-0.533,p=0.595)。DAA组术前和术后的血红蛋白值差异(2.074±1.283 g/d L)低于PA组(2.595±1.310 g/d L)。该项结果差异无统计学意义(t=-1.764,p=0.082)。DAA组术后伤口平均失血量(223.57±118.195 m L)少于PA组(254.42±114.024 m L)。该项结果差异无统计学意义(t=-1.169,p=0.246)。DAA组和PA组在术后两周、四周及六周的Harris髋关节评分(HHS)差异具有显著的统计学意义。术后两周,DAA组HHS的平均值(53.60±4.888)高于PA组(47.00±6.381);t=7.627,p=0.000。术后四周,DAA组HHS的平均值(66.74±2.683)高于PA组(62.84±1.825);t=7.627,p=0.000。术后六周,DAA组HHS的平均值(78.17±4.253)高于PA组(72.51±1.932);t=7.802,p=0.000。当术后十二周,六个月,一年后再次测评HHS,DAA组和PA组无显著差异。PA组的BMI与HHS在术后两周呈负相关,此结果具有统计学意义(r=-0.331,p=0.030).在本研究中,两组病例均无术后并发症(移位、骨折等情况)出现,所以无法在本研究中进行比较并发症的发生率。结论:本研究表明,采用Harris髋关节评分法(HHS)评估的早期功能比较结果的差异,是DAA组和PA组两组间的主要差异,而其他数据无显著统计学差异,即使是有差异的早期功能评分,在术后12周,6个月,1年后再次测评,两组无显著差异。那么,只基于单一因素无法判定DAA入路是否优于PA入路,目前的实际临床工作中,两种手术入路具有各自的特点,临床医生针对大部分病人,选用合适的入路,都能很好地实施全髋关节置换术,获得满意的功能重建。最佳的手术入路取决于患者的自身状况及术者经验。在选择股骨头坏死手术入路之前需要结合几个因素来考虑。通过本研究,进一步为临床工作提供了参考数据
[Abstract]:Background: total hip arthroplasty is the main treatment for osteonecrosis of the femoral head. Total hip arthroplasty has undergone many stages in terms of surgical techniques and internal plant materials. With time, all aspects of the operation have been improved to make patients and doctors benefit more. There are many kinds of surgical methods for total hip replacement. These methods have their own advantages and disadvantages. The two most commonly used methods are direct anterior or posterior operation. In order to find the best method of operation, many scholars have done a lot of research, but there is no consensus in the academic circle. In this study, the author tries to look back on the related surgical data of the undergraduate room. In order to achieve this goal, the authors measured the preoperative, intraoperative and postoperative indexes, statistical analysis, and combined with the study of postoperative complications. Patients' materials and research methods: This study was at the Dalian Medical University hospital. Joint surgery was performed on the patients with femoral head necrosis who received total hip replacement from September 2014 to December 2016. We selected 78 patients aged from 39 to 89 years old. According to the different surgical approaches, 78 patients were divided into two groups: the direct anterior approach group (DAA) and the posterolateral approach group (PA) group.DAA Including 35 patients, of which 20 women and 15 men, age range from 44 to 89 years old, including 43 patients, 20 women and 23 men, age range from 39 to 81 years old. The comparison and retrospective study is based on the following parameters: (a) age, (b) sex (c) body mass index (BMI); (2) preoperative parameters: (a) Harris Hip score, HHS (preoperative) (preoperative) (b) hemoglobin index (preoperative); (3) intraoperative parameters: (a) long operation time; (b) blood loss during operation; (4) postoperative parameters (a) bleeding volume (blood volume in drainage bag), (b) difference in hemoglobin value (preoperative and postoperative comparison), (c) postoperative hospital days, and (d) the Harris hip joint score at different time after operation (2) (2) Weeks, 4 weeks, 6 weeks, 12 weeks, 6 months, 1 years, and (E) postoperative imaging complications (displacement and fracture). Data were analyzed with SSPS software 22, descriptive statistics, t test, Pearson correlation and repeated measurements. Results: the average age of the direct anterior approach group (DAA) was 59.83 + 9.473 years, and the average age of the posterolateral approach group (PA) was 55.74 +. 9.781 years of age. Age differences (t=1.860, P=0.067) and gender differences (x2=0.873, P=0.350), the average body mass index (BMI) of the.DAA group was 24.978 + 3.002kg/m2 (range: 19.03-30.86 kg/m2).PA group, the average body mass index (BMI) was 25.189 + 3.009 kg/m2 (range: average body mass index). No statistical significance (t=-0.309, p=0.758). Preoperative parameters: preoperative DAA group Harris hip joint score (HHS) was 44 + 7.046, PA group was 44.70 + 10.232. and there was no statistical difference (t=-0.342 p=0.733). The mean value of hemoglobin in the DAA group before operation was 13.157 + 1.398 g/d L, and 13.714 + 1.509 No statistical significance (t=-1.675, p=0.098). Intraoperative parameters: the average time of operation in group DAA (81.86 + 13.778 minutes) was longer than that of group PA (77.79 + 13.597 minutes). There was no statistically significant difference (275.71 + 129.689 m L) in group.DAA (275.71 + 129.689 m L) in group.DAA (324.42 + 153.674 m L). There was no significant difference between the results of the results of the group (324.42 + 153.674 m L). (t=-1.491, p=0.140) after operation: the time of postoperative hospitalization in group DAA (14.31 + 5.90 days) was shorter than group PA (15.12 + 7.13 days). There was no statistically significant difference (t=-0.533, p=0.595) in group.DAA (2.074 + 1.283 g/d L) before and after operation (2.595 + 1.310 g/d L). =0.082) the average blood loss in group.DAA after operation (223.57 + 118.195 m L) was less than that in group PA (254.42 + 114.024 m L). There was no statistical significance (t=-1.169, p=0.246) in.DAA group and PA group at two weeks after operation, and the difference between the four weeks and six weeks was statistically significant. Two weeks after the operation, the average value (53.) 60 + 4.888) was higher than that of group PA (47 + 6.381); t=7.627, after p=0.000., the mean value of HHS in group DAA was higher than that in group PA (62.84 + 1.825); t=7.627, 6 weeks after p=0.000., and the average value of HHS in group DAA (78.17 + 4.253) higher than that in PA group (72.51 + 1.932). There was no significant difference in group.PA between BMI and HHS at two weeks postoperatively. The results were statistically significant (r=-0.331, p=0.030). In this study, there were no postoperative complications (displacement, fracture, etc.) in the two groups, so there was no comparison and incidence of complications in this study. Conclusion: this study showed that Harris hip joint was used in this study. The difference between the results of the early functional comparison of the score method (HHS) was the main difference between the two groups in group DAA and group PA, but there was no significant difference in other data. Even if there was a different early functional score, there was no significant difference between the two groups at 12 weeks, 6 months, and 1 years after the operation. Then, only a single factor could not determine whether the DAA approach was in the way. In the actual clinical work, two kinds of surgical approaches have their own characteristics in the actual clinical work. The clinicians can perform the total hip replacement and obtain satisfactory functional reconstruction. The best approach depends on the patient's own condition and the experience of the surgeon. There are several factors to consider before the operation of necrotizing. This study provides reference data for clinical work.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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