直接上方入路与后外侧入路全髋关节置换术早期临床疗效的随机对照研究

Comparison of early clinical outcome between direct superior approach and posterolateral approach in total hip arthroplasty: A randomized controlled study

背景:手术入路是影响髋关节置换快速康复的重要因素,不同入路患者术后康复时间存在差异。目的:比较直接上方入路(direct superior approach,DSA)和后外侧入路(posterolateral approach,PLA)全髋关节置换(total hip arthroplasty,THA)的早期临床疗效。方法:前瞻性连续纳入2020年1月至2020年6月行THA的患者60例(60髋),随机分为DSA组(30例)与PLA组(30例)。比较两组手术时间、切口长度、总失血量、起始下地时间、疼痛视觉模拟评分(VAS)、髋关节Harris评分、术后双下肢不等长(LLD)和并发症等。结果:DSA组平均随访9.3个月,PLA组平均随访8.9个月。与PLA组相比,DSA组的手术时间更长[(99±11)min比(78±21)min]、总出血量更少[(482±236)ml比(680±299)ml]、切口更短[(8.8±0.6)cm比(13.9±1.1)cm]、下地时间更早[(15.8±4.0)h比(20.5±3.5)h],差异均具有统计学意义(P<0.05)。DSA组术后3 d局部疼痛VAS评分低于PLA组。两组除术后第3天白细胞计数有统计学差异(P=0.039),C反应蛋白、D-二聚体、白细胞计数等术后实验室检查指标无统计学差异(P>0.05)。两组术后LLD以及随访时的Harris评分均无统计学差异(P>0.05)。结论:DSA入路THA的总出血量、术后3天疼痛评分、切口长度、起始下地时间均优于PLA入路,在THA早期快速康复的应用中有一定的优势。但两种入路术后半年随访临床疗效无明显差异。

Background:The surgical approach is an important factor for the enhanced recovery after total hip arthroplasty(THA).There are differences in the postoperative recovery time among patients with different surgical approaches.Objective:To compare early clinical outcome of direct superior approach(DSA)and posterolateral approach(PLA)in THA.Methods:Sixty patients(60 hips)who underwent THA from January 2020 to June 2020 were prospectively enrolled and randomly allocated into DSA group and PLA group(n=30).The operation time,incision length,total blood loss,out-of-bed time,visual analogue scale(VAS),Harris hip score,postoperative leg length discrepancy(LLD)and complications were compared between the two groups.Results:The average follow-up period was 9.3 months in DSA group and 8.9 months in PLA group.Compared with PLA group,DSA group had longer operation time([99±11]min vs.[78±21]min),less total blood loss([482±236]ml vs.[680±299]ml),shorter incision([8.8±0.6]cm vs.[13.9±1.1]cm),and earlier out-of-bed time([15.8±4.0]h vs.[20.5±3.5]h),with statistically significant differences(P<0.05).Local VAS scores of DSA group were lower than those of PLA group three days after operation.There was no significant difference in C-reactive protein(CRP),D-dimer or white blood cell(WBC)count between the two groups(P>0.05),except the WBC count on day 3 postoperatively(P=0.039).There was no difference in LLD or Harris score between the two groups(P>0.05).Conclusions:DSA approach is superior to PLA approach in total blood loss,3-day postoperative pain score,incision length and out-of-bed time.It has advantages in the early fast recovery after THA,but there is no significant difference between DSA approach and PL approach in clinical efficacy after half a year follow-up.