两种手术入路人工全髋关节置换术的疗效比较研究

Efficacy comparative study of two surgical approaches in total hip arthroplasty

目的:观察和比较直接外侧入路和后外侧入路行人工全髋关节置换术的术后临床疗效。方法:收集并随访2009年1月至2012年7月在我院行人工全髋关节置换的218例患者,其中直接外侧入路110例和后外侧入路108例,予以记录其手术时间、术中出血量、术后3月内并发症发生率(脱位、感染、深静脉血栓)、术后3月检测患侧髋关节Harris评分增加量及Trendelenburg试验阳性率,并进行统计学分析。结果:两组患者手术时间、术中出血量及术后3月内感染、深静脉血栓发生率差别无统计学意义。后外侧入路组术后3月内脱位发生率高于直接外侧入路,两组术后3月患侧髋关节Trendelenburg试验阳性率及Harris评分相仿。结论:直接外侧入路与后侧入路行人工全髋关节置换术的临床效果并无明显差异,但选择后外侧入路时,应尽量对外旋肌群进行修复,减少术后脱位的发生。

Objective：To investigate and compare the clinical effect of total hip arthroplasty using the direct lateral and posterolateral approach.Methods： From January 2009 to July 2012,a total of 218 patients undergone total hip arthroplasty in our hospital（110 cases,direct lateral approach,108 cases,posterolateral approach）.The surgical data including operative time,blood loss and complications 3 months after surgery（dislocation,infection,deep venous thrombosis） were recorded.Harris Hip score and Trendelenburg＇s test were measured 3 months after surgery.The results was analysised with statistics.Results： There were no significant difference in surgical data and the incidence of infection and deep venous thrombosis 3 months after sugery（P 0.05）.The incidence of dislocation in posterolateral approach group was higher than direct lateral group（P 0.05）.The increase of Harris scores and Positive rate of Trendelenburg test of two groups 3 months after surgery were similar（P 0.05）.Conclusion： There was no significant difference in hip function recovery between the direct lateral approach and the posterolateral approach.But when choosing the posterolateral approach,reconstructing the external rotator muscles carefully to reduce dislocation rate shoul be carefully considered.