前侧入路在肥胖症患者全髋关节置换术中的应用价值

Application value of anterior approach for total hip arthroplasty in obese patients

目的：探讨前侧入路在肥胖症患者全髋关节置换术（total hip arthroplasty，THA）中的应用价值。方法回顾性分析2013年3月至2015年6月在揭阳市人民医院骨外一科行THA治疗的45例肥胖症患者的临床资料。所有患者均签署知情同意书，符合医学伦理学规定。根据手术入路方式的不同将患者分为前侧入路组（A组）和后外侧入路组（B组）。其中A组18例，男6例，女12例；平均年龄（61±6）岁。B组27例，男8例，女19例；平均年龄（63±6）岁。比较两组患者性别、年龄、体质指数、手术时间、术中出血量、下地时间、Harris评分、并发症发生率、假体位置和角度等指标。两组患者临床指标的比较采用t检验和χ2检验。结果 A组手术时间为（75±11）min，明显长于B组的（57±9）min（t=6.457，P＜0.05）；A组术中出血量为（312±58）ml，明显少于B组的（376±79）ml（t=2.876，P＜0.05）；A组术后下地时间为（1.4±1.2）d，明显早于B组的（2.2±1.4）d（t=3.156，P＜0.05）。术后6个月，A组患者的假体前倾角和外展角分别为（17±7）°和（39±9）°，与B组的（18±8）°和（39±7）°差异无统计学意义（t=1.246、0.947，P＞0.05）；A组患者的髋关节Harris评分为（83±16）分，与B组的（85±17）分差异无统计学意义（t=1.137， P＞0.05）；A组患者髋关节脱位、下肢血栓形成、切口非感染性并发症和切口感染的发生率分别为0.0%（0/18）、11.1%（2/18）、11.1%（2/18）和5.5%（1/18），与B组的7.4%（2/27）、14.8%（4/27）、18.5%（5/27）和7.4%（2/27）差异无统计学意义（χ2=2.105、0.131、0.467、0.061，P＞0.05）。结论在THA中采用前侧入路能较好地保护肥胖症患者的周围软组织，创伤性小，并发症发生率低，术后髋关节功能恢复良好，值得在临床上进一步推广使用。

ObjectiveTo investigate the application value of anterior approach for total hip arthroplasty （THA） in obese patients.Methods Clinical data of 45 obese patients undergoing THA in the First People’s Hospital of Jieyang from March 2013 to June 2015 was retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. These patients were divided into the anterior approach group （group A） and the posterolateral approach group （group B） according to different surgical approaches. Among the 18 patients of group A, 6 were males and 12 were females with an average age of （61±6） years old. Among the 27 patients of group B, 8 were males and 19 were females with an average age of （63±6） years old. Indexes of gender, age, body mass index, operation time, intraoperative blood loss, ambulation time, Harris hip score, complication incidence, prosthesis position and angle were compared between the two groups. The comparisons of these clinical indexes were conducted usingt test andχ2 test.Results The operation time of group A was （75±11） min, which was significantly onger than （57±9） min of group B （t=6.457,P〈0.05）; the intraoperative blood loss of group A was （312±58） ml, which was significantly less than （376±79） ml of group B （t=2.876,P〈0.05）; and the ambulation time of group A was （1.4±1.2） d, which was significantly earlier than （2.2±1.4） d of group B （t=3.156,P〈0.05）. At 6 months after surgery, the anteversion angle and abduction angle of prosthesis in group A were （17±7）° and （39±9）° respectively, which had no statistical differences with （18±8）° and （39±7）° of group B respectively （t=1.246, 0.947,P〉0.05）; the average Harris score of group A was 83±16, which had no statistical differences with 85±17 of group B （t=1.137,P〉0.05）; the occurrence rates of hip dislocation, lower limb thrombosis, non-infective incision complication and infective incision complication in group A were 0.0% （0/18）, 11.1% （2/18）, 11.1% （2/18） and 5.5% （1/18） respectively, which had no statistical differences with 7.4% （2/27）, 14.8% （4/27）, 18.5% （5/27） and 7.4% （2/27） of group B respectively （χ2=2.105, 0.131, 0.467, 0.061,P〉0.05）.Conclusions Anterior approach for THA in obese patients can protect the surrounding soft tissue with little trauma, low complication incidence and good recovery of hip function, so it’s worthy to be used more widely.