本文關(guān)鍵詞： 直接前方入路 全髖關(guān)節(jié)置換 側(cè)臥位 并發(fā)癥 學(xué)習(xí)曲線　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的直接前方入路(direct anterior approach,DAA)全髖關(guān)節(jié)置換通過神經(jīng)界面和肌肉間隙顯露髖關(guān)節(jié),是一真正的微創(chuàng)手術(shù)入路。然而,側(cè)臥位DAA全髖關(guān)節(jié)置換文獻(xiàn)鮮見報(bào)道,本研究目的在于評(píng)價(jià)側(cè)臥位DAA的技術(shù)可行性和早期臨床效果、影像學(xué)結(jié)果和手術(shù)并發(fā)癥。方法本研究是一項(xiàng)前瞻性、無對(duì)照、評(píng)估者盲法的單中心觀察性試驗(yàn)。2014年7月1日至2014年12月31日,我院骨科共招募248人(295髖)需要行初次全髖關(guān)節(jié)置換術(shù)治療的患者,依據(jù)納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)共126髖完成初次側(cè)臥位直接前方入路全髖關(guān)節(jié)置換術(shù)。經(jīng)過術(shù)后12個(gè)月隨訪,117髖獲得完整的臨床和影像學(xué)隨訪資料,評(píng)估側(cè)臥位直接前方入路全髖關(guān)節(jié)置換術(shù)的早期隨訪結(jié)果。結(jié)果平均手術(shù)時(shí)間72分鐘(59-160分鐘),平均術(shù)中出血329ml(185-655ml)。平均髖關(guān)節(jié)Harris評(píng)分術(shù)后1個(gè)月為82.1(74-90)分,術(shù)后3個(gè)月為86.0(79-95)分,術(shù)后12個(gè)月為88.6(80-96)分,均較術(shù)前53.2(44-65)分明顯改善(p0.001)。髖臼平均前傾角為16.5°±4.9°,外展角為43.3°±3.5°。98髖(83.8%)髖臼假體的前傾角和外展角位于“安全范圍”內(nèi)。雙下肢長(zhǎng)度差異由術(shù)前11mm(0-22mm)糾正為術(shù)后3m(-5-15mm)(Wilcoxon符號(hào)秩和檢驗(yàn),Z=-8.27,p0.001)。43髖(36.8%)發(fā)生股外側(cè)皮神經(jīng)損傷,1髖發(fā)生術(shù)中股骨近端骨折,2髖術(shù)后早期出現(xiàn)髖關(guān)節(jié)脫位,3髖髖臼杯未完全打入臼窩。所有病例術(shù)后1年隨訪未發(fā)生術(shù)后假體周圍骨折、無菌性假體松動(dòng)。結(jié)論早期臨床和影像學(xué)隨訪結(jié)果證實(shí)側(cè)臥位直接入路全髖關(guān)節(jié)置換手術(shù)技術(shù)安全可行。當(dāng)無特殊手術(shù)床或牽引床時(shí),可考慮側(cè)臥位直接前方入路替代平臥位直接前方入路,有利于直接前方入路的推廣。
[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 擄鹵4.9 擄, and the abduction angle was 43.3 擄鹵3.5 擄.98 hip axis angle was 83.8 擄) 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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4

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