侧卧位前方入路与后外侧入路在全髋关节置换术中的应用效果对比研究

Comparison of Direct Anterior Approach and Posterolateral Approach in Total Hip Arthroplasty

目的探讨侧卧位前方入路与后外侧入路在全髋关节置换术中的临床疗效。方法选择需要进行全髋关节置换术患者120例,随机分为观察组(n=60)与对照组(n=60),观察组行侧卧位前方入路手术,对照组行后外侧入路手术,比较两组患者手术时间、切口长度、术中出血量、术后引流量、下床行走时间、住院时间、Harris髋关节功能评分(HHS)、平均股骨头假体直径、髋臼前倾角、髋臼外展角。结果观察组患者切口长度短于对照组(P<0.05),术中出血量、术后引流量少于对照组(P<0.05),下床行走时间、住院时间短于对照组(P<0.05);两组手术时间比较,差异无统计学意义(P>0.05)。两组患者HHS评分、平均股骨头假体直径、髋臼前倾角、髋臼外展角比较,差异无统计学意义(P>0.05);观察组患者无脱位情况发生。对照组患者3例发生髋关节后脱位,占5%。结论直接前方入路与后外侧入路全髋关节置换比较,具有出血少、疼痛轻、脱位发生率少、术后恢复快等优势。

Objective Compare the effect of direct anterior approach and posterolateral approach in total hip arthroplasty. Methods 120 cases of primary THA were divided into the observation group（n=60） and the control group（n=60）, the observation group were treated with direct anterior approach, the control group were treated with posterolateral approach, then the operation time, length of incision, amount of bleeding during operation, volume of drainage after the operation, time to get out of bed, the hospitalization time, HHS, femoral head prosthesis diameter, acetabular anteversion angle, abduction angle of acetabulum were contrasted between the two groups. Results The length of incision, amount of bleeding during operation, volume of drainage after the operation, time to get out of bed, the hospitalization time in the observation group were lower than the control group（P〈0.05）; There was no significantly difference in the operation time, HHS, femoral head prosthesis diameter, acetabular anteversion angle, abduction angle of acetabulum between two groups（P〉0.05）. The observation group have no dislocation, the control group have 3 dislocation, accounted for 5%. Conclusion Compared with the posterolateral approach,the direct anterior approach in total hip arthroplasty had the advantages of less bleeding, less pain, anti dislocation ability and faster postoperative recovery.