【摘要】：目的對比分析直接前方入路(direct anterior approach,DAA)與后外側(cè)入路應用于同期雙髖置換的臨床療效,探討DAA在同期雙髖置換中的應用價值。方法回顧分析2010年6月—2015年11月采用DAA或后外側(cè)入路行同期雙髖置換的65例患者臨床資料,其中采用DAA同期雙髖置換34例(A組),采用后外側(cè)入路同期雙髖置換31例(B組)。兩組患者性別、年齡、體質(zhì)量指數(shù)、術(shù)前血紅蛋白水平、病因、病程、術(shù)前Harris評分及疼痛視覺模擬評分(VAS)比較,差異均無統(tǒng)計學意義(P0.05),具有可比性。記錄并比較兩組患者切口長度、手術(shù)時間、術(shù)中出血量、總輸血量、住院時間、術(shù)后早期并發(fā)癥及手術(shù)前后Harris評分、VAS評分,采用簡易Likert量表法進行患者滿意度評價,并行影像學評價。結(jié)果 A組切口長度、手術(shù)時間、術(shù)中出血量、總輸血量、住院時間均顯著優(yōu)于B組(P0.05)。兩組患者均獲隨訪,隨訪時間A組15~48個月,平均25.3個月;B組12~51個月,平均27.6個月。A組手術(shù)相關(guān)并發(fā)癥發(fā)生率(10.29%)明顯低于B組(19.35%)(χ~2=8.769,P=0.023)。除A組1髖髖臼前傾角大于正常值外,兩組其余患者髖臼前傾角及外展角均在正常范圍內(nèi)。A、B組各1髖假體不穩(wěn)定固定,其余股骨假體股骨距無明顯骨質(zhì)吸收,固定穩(wěn)定。兩組患者術(shù)后各時間點Harris評分及VAS評分均較術(shù)前顯著改善(P0.05),術(shù)后組內(nèi)各時間點間差異亦有統(tǒng)計學意義(P0.05)。A組術(shù)后1、3個月Harris評分及術(shù)后3 d VAS評分均顯著優(yōu)于B組(P0.05);但末次隨訪時兩組上述評分比較差異均無統(tǒng)計學意義(P0.05)。根據(jù)簡易Likert量表法評價患者滿意度,A組綜合滿意度97.1%(33/34),B組為67.7%(21/31),兩組比較差異有統(tǒng)計學意義(χ~2=10.343,P=0.001)。結(jié)論 DAA應用于同期雙髖置換能顯著改善患者疼痛、加速髖關(guān)節(jié)功能恢復及提高患者滿意度,但臨床應用中需嚴格把握適應證,預防早期并發(fā)癥,其遠期療效有待進一步觀察。
[Abstract]:Objective to compare the clinical efficacy of direct anterior approach (direct anterior approach,DAA) and posterolateral approach in double hip replacement at the same time, and to explore the value of DAA in double hip replacement at the same time. Methods the clinical data of 65 patients undergoing simultaneous double hip replacement by DAA or posterolateral approach from June 2010 to November 2015 were analyzed retrospectively. among them, 34 patients were treated with DAA at the same time as double hip replacement (group A) and 31 patients were treated with posterolateral approach at the same time as double hip replacement (group B). There was no significant difference in sex, age, body mass index, preoperative hemoglobin level, etiology, course of disease, preoperative Harris score and pain visual simulation score between the two groups (P 0.05). The incision length, operation time, intraoperative blood loss, total blood transfusion, hospitalization time, early postoperative complications, Harris score before and after operation, VAS score were recorded and compared between the two groups. The patient satisfaction was evaluated by simple Likert scale method, and the imaging evaluation was performed. Results the length of incision, operation time, intraoperative blood loss, total blood transfusion and hospitalization time in group A were significantly better than those in group B (P 0.05). The patients in group A were followed up for 15 times 48 months (mean 25.3 months) and group B (12 months 51 months, mean 27.6 months). The incidence of operative complications in group A (10.29%) was significantly lower than that in group B (19.35%) (蠂 ~ 2 鈮，

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