直接外侧与后外侧入路初次全髋关节置换疗效比较研究

Comparison of clinical effects between direct lateral and posterolateral approach for primary total hip arthroplasty

目的比较直接外侧入路与后外侧入路初次全髋关节置换术(THA)的临床疗效。方法回顾性分析2009年6月至2014年5月于南京医科大学附属苏州医院行初次单侧THA治疗的102例患者的临床资料,其中直接外侧入路46例、后外侧入路56例。记录两组患者的手术时间、术中出血量、切口长度、术后并发症、术后6个月Harris髋关节功能评分及侧方外展时间试验结果。结果两组患者在手术时间、术中出血量、术后6个月Harris髋关节功能评分及侧方外展时间百分比方面无显著差异(P>0.05);但直接外侧入路组手术切口长度短于后外侧入路组(P<0.05),后外侧入路组患者术后2例脱位、1例坐骨神经损伤,直接外侧入路组无一例出现术后并发症。结论直接外侧入路与后外侧入路THA术后均可获得满意的临床效果,髋关节功能明显改善,侧方外展功能恢复良好;直接外侧入路THA在缩短手术切口和减少术后并发症方面似乎更具优势。

Objective To compare the clinical effects of primary total hip arthroplasty (THA) using direct lateral versus posterolateral approach. Methods From June 2009 to May 2014, a total of 102 patients performed primary unilateral THA in Suzhou Affiliated Hospital of Nanjing Medical University, among them 46 patients operated through direct lateral approach, and 56 patients through posterior lateral approach. Their clinical data were analyzed retrospectively, and the operating time, intraoperative estimate blood loss, length of incision, postoperative complications, as well as Harris hip function score and lateral abduction time at 6 months postoperatively were recorded. Results There were no significant differences in operating time, intraoperative estimate blood loss, Harris hip function score and lateral abduction time percentage at 6 months postoperatively&nbsp;between two groups (P>0.05). However, the incision length in direct lateral approach group was shorter than that in posterolateral approach group (P <0.05). Two cases of dislocation and 1 case of sciatic nerve injury occurred in posterolateral group, while there was no postoperative complication in direct lateral approach group. Conclusions Satisfactory therapeutic effects could be obtained by THA procedure either through direct lateral or posterolateral approach; It seems that THA through direct lateral approach has advantages of shortening incision length and reducing postoperative complications compared with posterolateral approach.