發(fā)布時(shí)間：2018-05-27 13:08

  本文選題：關(guān)節(jié)成形術(shù) + 置換　； 參考：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年02期

【摘要】：目的:探討直接前入路(direct anterior approach,DAA)行人工全髖關(guān)節(jié)置換術(shù)后早期效果及患者手術(shù)前后的步態(tài)變化。方法:20例因股骨頭壞死或髖關(guān)節(jié)發(fā)育不良繼發(fā)骨關(guān)節(jié)炎的患者于直接前入路下行單側(cè)初次人工關(guān)節(jié)置換,采集患者一般資料并記錄患者術(shù)前、術(shù)后視覺(jué)模擬評(píng)分(visual analogue scale,VAS)、Harris評(píng)分等,分別于手術(shù)前及手術(shù)后6周、12周行步態(tài)分析,記錄并分析患者手術(shù)前后步態(tài)變化并與正常成人對(duì)比。結(jié)果:患者術(shù)后平均住院時(shí)間3.3 d,術(shù)后3 d內(nèi)VAS評(píng)分均低于4分,患者假體安放位置滿(mǎn)意,至術(shù)后12周隨訪(fǎng)無(wú)脫位。步態(tài)分析結(jié)果中,步速患者組為術(shù)前0.64 m/s、術(shù)后6周0.77 m/s、術(shù)后12周1.07 m/s,正常對(duì)照組為1.19 m/s;步頻患者組為術(shù)前43.15步/min、術(shù)后6周51.42步/min、術(shù)后12周55.52步/min,正常對(duì)照組為57.15步/min;行走時(shí)髖關(guān)節(jié)活動(dòng)度患者組為術(shù)前31.00°、術(shù)后6周39.62°、術(shù)后12周40.40°,正常對(duì)照組為45.67°;行走時(shí)膝關(guān)節(jié)活動(dòng)度患者組為術(shù)前50.52°、術(shù)后6周59.28°、術(shù)后12周67.29°,正常對(duì)照組為70.42°。患者組內(nèi)比較,除術(shù)后6周的步速和行走時(shí)膝關(guān)節(jié)活動(dòng)度外其他數(shù)據(jù)差異均有統(tǒng)計(jì)學(xué)意義;與正常對(duì)照組相比,入組患者的步態(tài)分析數(shù)據(jù)仍不及正常對(duì)照,術(shù)后12周時(shí)患者步態(tài)數(shù)據(jù)已接近正常對(duì)照組,步速、步頻、行走時(shí)膝關(guān)節(jié)活動(dòng)度結(jié)果組間差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:DAA作為全髖關(guān)節(jié)置換的可選手術(shù)入路,患者術(shù)后12周步態(tài)已接近正常人群,但尚需進(jìn)一步的更大樣本量的研究。
[Abstract]:Objective: to investigate the early effect of direct anterior approach to total hip arthroplasty (THR) and the gait changes of the patients before and after operation. Methods Twenty patients with osteoarthritis secondary to osteonecrosis of femoral head or dysplasia of hip joint underwent unilateral primary arthroplasty via direct anterior approach. The general data of the patients were collected and the visual analogue scores before and after operation were recorded. Gait analysis was performed before operation and 6 weeks and 12 weeks after operation. Gait changes before and after operation were recorded and analyzed and compared with normal adults. Results: the average hospitalization time was 3.3 days, and the VAS score was lower than 4 points within 3 days after operation. The prosthesis placement was satisfactory, and no dislocation was found at 12 weeks after operation. Gait analysis results, The walking rate group was 0.64 m / s before operation, 0.77 m / s at 6 weeks postoperatively, 1.07 m / s at 12 weeks after operation, and 1.19 m / s in normal control group, 43.15 steps per minute before operation, 51.42 steps / min at 6 weeks after operation, 55.52 steps / min at 12 weeks after operation and 57.15 steps / min in normal control group respectively. The range of motion was 31.00 擄before operation, 39.62 擄at 6 weeks after operation, 40.40 擄at 12 weeks after operation, 45.67 擄in normal control group, 50.52 擄before operation, 59.28 擄at 6 weeks after operation, 67.29 擄at 12 weeks after operation and 70.42 擄in normal control group. Compared with the control group, the gait analysis data of the patients were not as good as those of the normal control group, except the walking speed at 6 weeks after operation and the knee joint motion at the time of walking, and the gait analysis data of the patients in the group were not as good as those in the normal control group. At 12 weeks after operation, the gait data of the patients were close to that of the normal control group, and there was no significant difference between the two groups in the results of step speed, gait frequency and knee joint motion during walking. Conclusion as an alternative approach to total hip replacement, the gait of the patients at 12 weeks after operation is close to the normal population, but further research is needed.
【作者單位】： 四川大學(xué)華西醫(yī)院骨科;
【基金】：衛(wèi)生部衛(wèi)生公益性行業(yè)科研專(zhuān)項(xiàng)(201302007)資助~~
【分類(lèi)號(hào)】：R687.4

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