DAA入路短柄全髋关节置换术中短期疗效随访结果

Short to midterm follow-up of short stem total hip arthroplasty with DAA approach

目的探讨采用直接前方入路（DAA）行Metha短柄全髋关节置换的手术技巧及适应证选择，报道中短期随访结果。方法回顾性分析自2011-06--2014-03采用DAA入路行全髋关节置换的35例（37髋）髋关节疾息，分别从手术时间、术中出血量、术后首次直腿抬高时间、VAS评分、Harris评分及影像学方面进行评估。结果本组获18-49（35．23±9．43）个月随访，手术时间80～110（93．60±8．92）min，术中出血量220-380（272．45±15．40）ml。所有患者髋关节功能均获明显改善，VAS评分由术前4～8（5．65±1．26）分改善为术后1个月1-3（2．65±0．26）分。髋关节Harris评分由术前35-60（46．25±10．24）分改善为末次随访87-96（92．02±3．18）分。无股外侧皮神经损伤、假体松动、假体周围感染和深静脉血栓栓塞等并发症发生。末次随访无一例需行翻修术。结论DAA为肌肉神经间隙入路，软组织损伤小、术后康复快，是一种可靠微创入路；Metha短柄的设计可以保留宿主骨量，适合微创置入，具有较好的力学传导性能；DAA入路行Metha短柄全髋关节置换可取得满意的中短期疗效。

Objective To explore the surgical techniques, indications and short to midterm results of total hip arthroplasty with Metha short stem through DAA approach （direct anterior approach, DAA）. Methods Thirty five patients （37 hips） undergoing total hip replacement in our hospital from June 2011 to March 2014 through DAA approach were retrospectively reviewed： The average operation time, blood loss, first straight leg raising time, VAS score, Harris score and imaging were evaluated. Results All patients were followed up for 18-49（35.23±9.43）months. Operative time was 80-110（93.60±8.92）rain, blood loss was 220-380（272.45±15.40）ml, and the first straight leg raising time was 1-4（2.15±1.08） days after operation. All patients hip function was significantly improved. The VAS score was improved from 4-8 （5.65±1.26）to 1-3 （2.65±0.26） one month after operation and Harris hip score improved from 35-60 （46.25±10.24） to 85-95 （90.13±5.07） one month after operation and 87-96 （92.02±3.18） at last follow-up. There was no injury of lateral femoral cutaneous nerve, no prosthesis loosening, no peri-prosthetic joint infection and no deep venous thrombosis or other complications. No revision was performed up to the last follow-up. Conclusion DAA is an approach through nerve and muscle gap with minimal soft tissue invasion. Metha stem is designed to preserve the host bone with good mechanical properties. The short to midterm result of total hip arthroplasty with Metha stem through DAA approach is satisfactory.