摘要
目的比较侧卧位直接前方入路(direct anterior approach,DAA)与传统后外侧入路(posterolateralapproach,PLA)行初次全髋关节置换术(total hip arthroplatsy,THA)的临床疗效。方法回顾性分析2016年1月至2017年12月期间西南医科大学附属医院骨关节外科收治的初次全髋关节置换术患者102例,分为DAA组51例,PLA组51例,两组患者性别、年龄等一般资料比较差异无统计学意义(P>0.05),具有可比性。比较两组手术时间、切口长度、术中失血量、术后引流量、髋臼假体位置、住院时间,观察并发症发生情况;采用Harris评分评价髋关节功能恢复情况。结果两组患者均得随访,随访时间7~16个月,平均9.6个月。DAA组手术时间为(66.8±11.3)min,PLA组手术时间为(62.9±9.2)min,差异无统计学意义(P>0.05)。两组切口长度分别为(7.2±1.6)cm和(9.8±3.1)cm、术中出血量分别为(58.3±11.2)mL和(86.8±12.3)mL、术后引流量分别为(64.8±12.6)mL和(125.1±11.2)mL、平均住院时间分别为(5.4±1.1)d和(7.8±1.8)d,两组比较差异有统计学意义(P<0.05);髋臼外展角分别为(38.4±6.2)°和(37.9±5.7)°、前倾角分别为(17.3±5.3)°和(18.6±5.1)°,两组比较差异无统计学意义(P>0.05)。关节功能恢复:术后1、3、6个月DAA组髋关节Harris评分分别为(82.6±10.8)、(92.1±10.6)、(93.7±8.9)分,PLA组为(71.4±9.6)、(87.5±9.1)、(92.7±9.2)分,两组比较差异有统计学意义(P<0.05),但末次随访时DAA组与PLA组Harris评分差异无统计学意义(P>0.05)。DAA组术后1、3、5、7d的VAS评分均低于PLA组,两组比较差异有统计学意义(P<0.05)。并发症发生情况:DAA组出现1例(1.9%)股外侧皮神经损伤,未见髋关节脱位病例。PLA组发生髋关节脱位3例(5.8%),未见神经损伤等症状。结论侧卧位直接前方入路与后外侧入路全髋关节置换比较,具有出血少、疼痛轻、脱位率低、术后康复快等优点,其早期疗效优于传统后外侧入路。
Objective To compare the clinical efficacy of the direct anterior approach（DAA）and the posterolateral approach（PLA）for total hip arthroplasty（THA）in the lateral decubitus position.Methods A retrospective study was performed on 102 patients who underwent primary unilateral THA that accepted in the Affiliated Hospital of Southwest Medical University from January 2016 to December 2017.There were 51 cases underwent DAA and 51 cases underwent posterolateral approach.There was no significant difference in gender,age etc.（P〉0.05）.The operation time,incision length,intraoperative blood loss,postoperative drainage,acetabulumposition,hospitalization time,postoperative complications and the Harris scores were recorded and compared.Results The patients had an average follow-up of 9.6（range,7-16）months.The operationtime in DAA and PLA was（66.8±11.3）minutes and（62.9±9.2）minutes,respectively.There was no significant difference in operation time between 2 groups（P〈0.05）.The incision length in DAA and PLA was（7.2±1.6）cm and（9.8±3.1）cm,respectively.The intraoperative blood loss was（58.3±11.2）mL and（86.8±12.3）mL,respectively.The postoperative drainage was（64.8±12.6）mL and（125.1±11.2）mL,respectively.The hospitalization time was（5.4±1.1）days and（7.8±1.8）days,respectively.There were statistically significant differences between the two groups in incision length,intraoperative blood loss,postoperative drainage and hospitalization time（P〈0.05）.The acetabular abduction angle was（38.4±6.2）°in the anterior group and was（37.9±5.7）°in the posterolateralgroup,showing no significant difference（P〉0.05）.The acetabularanteversion angle was（17.3±5.3）°in the anterior group and was（18.6±5.1）°in the posterolateral group,showing no significant difference（P〉0.05）.Harris scores of DAA was higher than that of PLA group after 1 month and 3 months of operation,the difference was statistically significant（P〈0.05）.Harris scores betweenthe two groups had no statistical significance in postoperative 6 months and latest follow-up（P〉0.05）.Further analysis,at 3 months after operation,the joint function score in DAA group was significantly higher than that in PLA group（P〈0.05）,while there was no significant difference in the pain score and range of motion score between 2 groups（P〉0.05）.VAS of DAA was less than that of PLA after 1 day,3 days,5 days and 7 days of operation,the difference between the two groups was statistically significant（P〈0.05）.There were 3 cases（5.8%）of postoperative dislocation in PLA and no dislocation in DAA.There was 1 case（3.2%）of lateral femoral cutaneous nerve injury in DAA.Conclusion Compared with the posterolateral approach,the direct anterior approach in the lateral decubitus position in total hip arthroplasty had the advantages of less bleeding,lesspain,faster postoperative recovery at early follow-up.
作者
邓翔天
刘俊才
李忠
陈歌
尹一然
杨顺成
岳永川
赫明亮
Deng Xiangtian;Liu Juncai;Li Zhong(Department of Orthopedics,The Affiliated Hospital of Southwest Medical University,Luzhou 646000,Chin)
出处
《实用骨科杂志》
2018年第8期692-695,700,共5页
Journal of Practical Orthopaedics
关键词
侧卧位
直接前方入路
后外侧入路
髋关节置换
lateral decubitus position
direct anterior approach
posterolateral approach
total hip arthroplasty
