侧卧位直接前方入路与后外侧入路全髋关节置换临床疗效比较

Direct anterior approach versus posterolateral approach for total hip arthroplasty in the lateral decubitus position

目的比较侧卧位直接前方入路与后外侧入路全髋关节置换术的临床疗效。方法2014年7至12月间在安徽医科大学附属省立医院骨科行单侧初次全髋关节置换术患者104例，数字表法随机分为直接前方入路组（DAA）和后外侧入路组（PLA）。所有手术均由同一组医师完成。对两组患者的一般状况、围手术期各指标以及术后随访功能康复及影像学Harris评分、WOMAC评分以及视觉模拟评分（VAS）评价进行统计分析。结果两组患者均得到有效随访，随访时间10～16个月，平均14个月。两组在手术时间、切口长度、术前血红蛋白（Hb）浓度以及输血例数上差异无统计学意义（P〉0．05）。DAA组术中出血量与术后引流量明显低于PLA组，而术后Hb浓度则明显高于PLA组（P〈0．05）。DAA组术后1个月Harris评分[（83．6±7．1）比（79．8±6．6），P〈0．05]、WOMAC评分[（28．9±6．1）比（36．1±6．9），P〈0．001]以及VAS评分[（2．2±0．9）比（2．9±1．1），P〈0．05]均明显优于PLA组。两组病例在影像学评价以及不良事件发生率差异无统计学意义（P〉0．05）。结论侧卧位DAA全髋关节置换术与后外侧入路相比，在不影响患者临床疗效的前提下，能显著减少手术创伤、减轻术后疼痛、有利于术后早期康复，缩短术后恢复时间，是一种安全可靠有效的手术入路。

Objective To compare the clinical efficacy of the direct anterior approach （DAA） and the posterolateral approach （PLA） for total hip arthroplasty （THA） in the lateral decubitus position. Methods From July to December, 2014, 104 patients randomly divided into two equal groups of the DAA group and the PLA group underwent unilateral primary THA procedures. All procedures were performed by the same surgeon in the Department of Orthopaedics, the Affiliated Anhui Provincial Hospital of Anhui Medical University. General data, perioperative index, postoperative function and radiological evaluation were recorded and statistically analyzed. Results The patients had an average follow-up of 14 （range, 10 -16） months. No significant differences were detected with respect to the operation time, incision length, preoperative Hb concentration and transfusion rate between two groups （ P 〉 0. 05 for all comparisons）. However, there were significant differences associated with the intraoperative bleeding, postoperative drainage and postoperative Hb concentration in the two groups（P 〈 0. 05 for all comparisons）. The DAA group showed significant superior outcomes compared with the PLA group in the Harris hip scores [（83.6±7.1） vs （79.8±6.6）, P〈0.05], WOMAC[ （28.9±6.1） vs （36.1±6.9）, P〈0.001], and VAS pain scores [ （ 2. 2 ±0, 9 ） vs （2. 9 ±1. 1 ）, P 〈 0. 05 ] at 1 month after surgery. No differences were seen between the study groups in the evaluation of radiography and the incidence of adverse event （ P 〉 0. 05 for all comparisons）. Conclusions Compared with the posterolateral approach, the present study shows the exciting results in patients underwent the DAA THA in the lateral decubitus position at early follow-up. The advantages of THA using the DAA include less operative trauma, alleviation of postoperative pain, and faster postoperative rehabilitation. It is a safe, reliable and effective surgery approach.