直接前方入路与外侧入路全髋关节置换术治疗Crowe Ⅰ、Ⅱ型髋关节发育不良比较研究

A comparision of direct anterior approach and lateral approach for total hip arthroplasty in the treatment of CroweⅠ,Ⅱtype of hip dysplasia

目的评价直接前方入路(direct anterior approach,DAA)全髋关节置换术(total hip arthroplasty,THA)治疗Crowe I、II型髋关节发育不良(developmental dysplasia of the hip,DDH)的临床疗效。方法回顾性分析2012年6月至2015年10月,采用人工THA治疗的Crowe I、II型DDH患者47例,其中采用外侧入路组27例(27髋),DAA组20例(20髋)。统计两组切口长度、手术时间、术中出血量,术前、术后1周、1个月、3个月、6个月髋关节Harris评分,术后6个月假体位置及并发症情况。结果 DAA组和外侧入路组切口长度分别为(8.97±1.030)cm和(14.37±1.043)cm;出血量分别为(245.00±37.906)ml和(384.07±50.020)ml,经统计学分析差异有统计学意义(P<0.05);术后1周Harris评分分别为(71.15±7.962)分和(64.63±5.336)分,术后1个月分别为(79.80±4.916)分和(72.67±4.446)分,术后3个月分别为(89.80±3.270)分和(84.48±3.916)分。两组切口长度、出血量、术后1周、1个月、3个月的Harris评分比较,差异均有统计学意义(P<0.05)。两组手术时间、假体角度,术后6个月髋关节Harris评分差异无统计学意义(P>0.05)。外侧入路组1例出现大转子处疼痛,1例发生皮下血肿,21例输血;DAA组有2例出现股外侧皮神经损伤症状,5例患者输血。结论 DAA与外侧常规入路髋关节置换术相比,具有切口小、出血少、术后恢复快等优点,但远期髋关节功能相当。

Objective To evaluate the clinical effects of direct anterior approach（ DAA） for total hip arthroplasty in the treatment of Crowe I, II type of hip dysplasia. Methods From June 2012 to October 2015, 47 cases of Crowe I, II type developmental dysplasia of the hip were treated with total hip arthroplasty, including the lateral approach group 27 cases（ 27 hips） and the direct anterior approach group 20 cases（ 20 hips）. The operative incision length, operative time, intraoperative bleeding, Harris hip score preoperatively, 1 week postoperatively, 1 month postoperatively, 3 months postoperatively, 6 months postoperatively were analyzed. Prosthesis position of and complications 6 months postoperatively were observed. Results Operative incision length： DAA approach group（ 8.97 ± 1.030） cm, lateral approach group（ 14.37 ± 1.043） cm, statistically signifi cant（ P〈0.05）. The intraoperative bleeding： DAA approach group（ 245.00 ± 37.906） ml, lateral approach group（ 384.07 ± 50.020） ml, statistically significant（ P〈0.05）; Harris hip score 1 week postoperatively： DAA approach group（ 71.15 ± 7.962）, lateral approach group（ 64.63 ± 5.336）, statistically signifi cant（ P〈0.05）; Harris hip score 1 month postoperatively： DAA approach group（ 79.80 ± 4.916）, lateral approach group（ 72.67 ± 4.446）, statistically signifi cant（ P〈0.05）; Harris hip score 3 months postoperatively： DAA approach group（ 89.80 ± 3.270）, lateral approach group（ 84.48 ± 3.916）, statistically signifi cant（ P〈0.05）. The operation time, angle of prosthesis, Harris hip score 6 months postoperatively showed no significant statistical differences（ P〈0.05）. Greater trochanter pain occurred in 1 case, subcutaneous hematoma occurred in 1 case, and blood transfusion was applied in 21 cases in the lateral approach group. Femoral lateral cutaneous nerve injury symptom occurred in 2 cases and blood transfusion was applied in 5 cases in the direct anterior approach group. Conclusions Compared with the conventional approach, DAA has advantages of small incision, less bleeding, quicker recovery and so on, but the long-term hip joint functions are similar.