【摘要】：目的:比較初次全髖關(guān)節(jié)置換術(shù)中直接前方入路(direct anterior approach,DAA)和后外側(cè)入路(posterior approach,PA)的臨床療效和安全性。方法:回顧性分析2015年7—12月期間收治的初次全髖關(guān)節(jié)置換術(shù)患者92例,分為DAA組44例,PA組48例,隨訪時(shí)間7~13個(gè)月,平均10.2個(gè)月。比較2組手術(shù)時(shí)間、住院時(shí)間、出血量、髖臼假體位置、術(shù)后停止使用助行器時(shí)間、Harris髖關(guān)節(jié)功能評(píng)分、并發(fā)癥等。使用軟件SPSS 13.0對(duì)兩組數(shù)據(jù)進(jìn)行分析比較。結(jié)果:DAA組與PA組年齡[(58.0±11.9)歲vs.(61.0±10.4)歲]、體重指數(shù)(25.1±3.7 vs.24.7±3.3)差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。DAA組與PA組手術(shù)時(shí)間無明顯區(qū)別[(76.0±17.4)min vs.(71.0±14.3)min,P0.05],但住院時(shí)間明顯縮短[(3.8±1.7)d vs.(4.9±2.3)d,P0.05],出血量明顯減少[(238.0±55.3)m L vs.(387.0±61.2)m L,P0.05]。髖臼位置方面,DAA組和PA組髖臼前傾角(17.3°±5.3°vs.18.6°±5.1°)、髖臼外展角(38.5°±5.7°vs.37.7°±5.2°)差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。DAA組使用助行器時(shí)間明顯縮短[(24.6±7.8)d vs.(31.7±10.2)d,P0.05],術(shù)后6周隨訪時(shí)DAA組Harris評(píng)分更高[85.7±5.4 vs.81.3±6.1,P0.05],但末次隨訪時(shí)兩組間Harris評(píng)分差異無統(tǒng)計(jì)學(xué)意義(93.4±4.7 vs.92.3±5.3,P0.05)。DAA組出現(xiàn)1例(2.2%)大轉(zhuǎn)子骨折,1例(2.2%)股外側(cè)皮神經(jīng)損傷,未出現(xiàn)脫位病例;PA組出現(xiàn)1例(2.1%)髖關(guān)節(jié)后脫位,1例(2.1%)腹股溝區(qū)疼痛。兩組均未出現(xiàn)假體松動(dòng)、下肢深靜脈血栓、坐骨神經(jīng)損傷等并發(fā)癥。結(jié)論:全髖關(guān)節(jié)置換術(shù)中直接前方入路明顯比后外側(cè)入路疼痛輕、出血量少、下床時(shí)間早、住院時(shí)間短、假體位置更佳,短期效果肯定,可獲得快速康復(fù)及良好的關(guān)節(jié)穩(wěn)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.
【作者單位】： 第二軍醫(yī)大學(xué)附屬長(zhǎng)海醫(yī)院關(guān)節(jié)骨病外科;
【分類號(hào)】：R687.4

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