全髋关节置换术中直接前方入路与后外侧入路的疗效及安全性分析

发布时间：2018-09-10 10:05

【摘要】：目的:比较初次全髋关节置换术中直接前方入路(direct anterior approach,DAA)和后外侧入路(posterior approach,PA)的临床疗效和安全性。方法:回顾性分析2015年7—12月期间收治的初次全髋关节置换术患者92例,分为DAA组44例,PA组48例,随访时间7~13个月,平均10.2个月。比较2组手术时间、住院时间、出血量、髋臼假体位置、术后停止使用助行器时间、Harris髋关节功能评分、并发症等。使用软件SPSS 13.0对两组数据进行分析比较。结果:DAA组与PA组年龄[(58.0±11.9)岁vs.(61.0±10.4)岁]、体重指数(25.1±3.7 vs.24.7±3.3)差异均无统计学意义(P0.05)。DAA组与PA组手术时间无明显区别[(76.0±17.4)min vs.(71.0±14.3)min,P0.05],但住院时间明显缩短[(3.8±1.7)d vs.(4.9±2.3)d,P0.05],出血量明显减少[(238.0±55.3)m L vs.(387.0±61.2)m L,P0.05]。髋臼位置方面,DAA组和PA组髋臼前倾角(17.3°±5.3°vs.18.6°±5.1°)、髋臼外展角(38.5°±5.7°vs.37.7°±5.2°)差异均无统计学意义(P0.05)。DAA组使用助行器时间明显缩短[(24.6±7.8)d vs.(31.7±10.2)d,P0.05],术后6周随访时DAA组Harris评分更高[85.7±5.4 vs.81.3±6.1,P0.05],但末次随访时两组间Harris评分差异无统计学意义(93.4±4.7 vs.92.3±5.3,P0.05)。DAA组出现1例(2.2%)大转子骨折,1例(2.2%)股外侧皮神经损伤,未出现脱位病例;PA组出现1例(2.1%)髋关节后脱位,1例(2.1%)腹股沟区疼痛。两组均未出现假体松动、下肢深静脉血栓、坐骨神经损伤等并发症。结论:全髋关节置换术中直接前方入路明显比后外侧入路疼痛轻、出血量少、下床时间早、住院时间短、假体位置更佳,短期效果肯定,可获得快速康复及良好的关节稳定性。
[Abstract]:Objective: To compare the clinical efficacy and safety of direct anterior approach (DAA) and posterior approach (PA) in primary total hip arthroplasty (THA). The operation time, hospital stay, bleeding volume, acetabular prosthesis position, postoperative stopping use of walker, Harris hip function score, complications, etc. were compared between the two groups using SPSS 13.0. Results: The age of DAA group and PA group [(58.0 6550 There was no significant difference in operative time between DAA group and PA group [(76.0 (+ 17.4) min vs. (71.0 (+ 14.3) min, P 0.05)], but the hospital stay was significantly shortened [(3.8 (+ 1.7) D vs. (4.9 (+ 2.3) d, P 0.05)], and the amount of bleeding was significantly reduced [(238.0 (+ 55.3) m L vs. (387.0 < 61.2) m L, P 0.05]. There was no significant difference in acetabular anteversion angle (17.3 [+5.3] vs. 18.6 [+5.1]) and acetabular abduction angle (38.5 [+5.7] vs. 37.7 [+5.2]. The use of walking aids in DAA group was significantly shortened [(24.6 [(7.8) days vs. (31.7 [10.2) days, P 0.05]. Harris score in DAA group was higher at 6 weeks follow-up [85.7 [5.4 vs. 81.3 [6.1, P 0.05]. There was no significant difference in Harris score between the two groups (93.4 +4.7 vs. 92.3 +5.3, P 0.05). In DAA group, 1 case (2.2%) had greater trochanter fracture, 1 case (2.2%) had lateral femoral cutaneous nerve injury and no dislocation; in PA group, 1 case (2.1%) had posterior dislocation of hip joint, 1 case (2.1%) had pain in groin area. Conclusion: Direct anterior approach in total hip arthroplasty has less pain, less bleeding, earlier time to get out of bed, shorter hospital stay, better prosthesis position and short-term effect than posterolateral approach.
【作者单位】：第二军医大学附属长海医院关节骨病外科;
【分类号】：R687.4

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