外侧与后外侧入路行全髋关节置换后关节功能恢复2年随访

Lateral versus posterolateral approach in total hip arthroplasty: restoration of joint function in 2-year follow-up

背景:不同的手术入路方式进行髋关节置换后临床疗效和髋关节功能恢复程度差别较大。目的:观察外侧与后外侧手术入路进行全髋关节置换,评价随访2年髋关节功能影响的差异。方法:收集2009年3月至2012年3月阳江市中医院骨科收治的93例髋关节置换患者,依患者手术入路情况分为外侧手术入路组(45例,60髋)及后外侧手术入路组(48例,60髋)。结果与结论:所有患者均得到较好的随访,平均随访2年,2组患者在手术时间、术后并发症、置换后中期髋关节功能恢复方面差异均无显著性意义(P>0.05),但是后外侧入路组在置换过程中出血量、切口长度、输血率、术后血红蛋白水平、置换后早期髋关节功能恢复均优于外侧入路组(P<0.05),但置换后2年时,2组患者疗效的差异无显著性意义(P>0.05)。且后外侧入路组和外侧入路组患者置换后感染、脱位、假体松动、骨水泥反应、术中致股骨近端骨折、静脉血栓栓塞等不良反应的发生率的差异无显著性意义(P>0.05)。提示采用后外侧入路行全髋关节置换有利于患者置换后早期恢复,但远期效果与外侧入路接近。

BACKGROUND：Clinical effects and the recovery of hip function after total hip arthroplasty via different approaches are quite different. OBJECTIVE：To observe total hip arthroplasty through lateral approach and posterolateral approach, and to evaluate the difference in hip function during 2-year fol ow-up. METHODS：Total y 93 patients who treated with total hip arthroplasty from March 2009 to March 2012 in the Department of Orthopedics, Yangjiang Municipal Traditional Chinese Medicine Hospital were enrol ed in this study. They were randomly divided into lateral approach group （45 cases, 60 hips） and posterolateral approach group （48 cases, 60 hips）. RESULTS AND CONCLUSION：Al patients were fol owed up for averagely 2 years. No significant difference in operation time, postoperative complications, and the recovery of hip function in the middle and late phases of replacement was visible （P〉0.05）. However, perioperative blood loss, operative length, blood transfusion rate, postoperative hemoglobin levels, and early postoperative hip joint functional recovery were better in the posterolateral approach group than in the lateral approach group （P〈0.05）. In the 2 years after replacement, no significant difference in therapeutic effects was detectable between the two groups （P〉0.05）. Moreover, no significant difference in the incidence of adverse reactions was visible such as postoperative infection, dislocation, loosening, bone cement reaction, intraoperative fractures of proximal end of the femur and venous thromboembolism between lateral approach and posterolateral approach groups （P〉0.05）. Results indicated that posterolateral approach in total hip arthroplasty is helpful to early recovery, but long-term effects are similar to lateral approach.