全髋关节置换术中直接前方入路与后外侧入路的疗效及安全性分析

Comparison of efficacy and safety between the anterior and the posterior approaches to total hip arthroplasty

目的:比较初次全髋关节置换术中直接前方入路(direct anterior approach,DAA)和后外侧入路(posterior approach,PA)的临床疗效和安全性。方法:回顾性分析2015年7—12月期间收治的初次全髋关节置换术患者92例,分为DAA组44例,PA组48例,随访时间7~13个月,平均10.2个月。比较2组手术时间、住院时间、出血量、髋臼假体位置、术后停止使用助行器时间、Harris髋关节功能评分、并发症等。使用软件SPSS 13.0对两组数据进行分析比较。结果:DAA组与PA组年龄[(58.0±11.9)岁vs.(61.0±10.4)岁]、体重指数(25.1±3.7 vs.24.7±3.3)差异均无统计学意义(P>0.05)。DAA组与PA组手术时间无明显区别[(76.0±17.4)min vs.(71.0±14.3)min,P>0.05],但住院时间明显缩短[(3.8±1.7)d vs.(4.9±2.3)d,P<0.05],出血量明显减少[(238.0±55.3)m L vs.(387.0±61.2)m L,P<0.05]。髋臼位置方面,DAA组和PA组髋臼前倾角(17.3°±5.3°vs.18.6°±5.1°)、髋臼外展角(38.5°±5.7°vs.37.7°±5.2°)差异均无统计学意义(P>0.05)。DAA组使用助行器时间明显缩短[(24.6±7.8)d vs.(31.7±10.2)d,P<0.05],术后6周随访时DAA组Harris评分更高[85.7±5.4 vs.81.3±6.1,P<0.05],但末次随访时两组间Harris评分差异无统计学意义(93.4±4.7 vs.92.3±5.3,P>0.05)。DAA组出现1例(2.2%)大转子骨折,1例(2.2%)股外侧皮神经损伤,未出现脱位病例;PA组出现1例(2.1%)髋关节后脱位,1例(2.1%)腹股沟区疼痛。两组均未出现假体松动、下肢深静脉血栓、坐骨神经损伤等并发症。结论:全髋关节置换术中直接前方入路明显比后外侧入路疼痛轻、出血量少、下床时间早、住院时间短、假体位置更佳,短期效果肯定,可获得快速康复及良好的关节稳定性。

Objective：To compare the efficacy and safety between direct anterior approach （DAA） and posterior approach （PA） in total hip arthroplasty.Methods： This study evaluated postoperative results of 92 consecutive total hip arthroplasties performed by a single surgeon;44 from the DAA,and 48 from PA.The age,body mass index,operation time,blood loss,hospital stay,positioning of the artificial hip,postoperative Harris score and postoperative complications were recorded and analyzed.Results： Both the average age of the patients separately （58.0±11.9） years in DAA group and （61.0±10.4） years in PA group and the body mass index （25.1±3.7） in DAA group and （24.7±3.3） in PA group,showed no significant difference between the two groups.The DAA group had significantly reduced the hospital stay （3.8±1.7） days vs.（4.9±2.3） days for the PA group （P〈0.05） and operation time was （76.0±17.4） min in DAA group,and （71.0±14.3） min in PA group （P〉0.05）.The amount of blood loss： in group DAA （238.0±55.3） mL,and in group PA （387.0±61.2） mL （P〈0.05）.There was no statistical difference in the positioning of the artificial hip： the cup anteversion in DAA group and PA group was 17.3°±5.3° vs.18.6°±5.1°,the cup inclination was 38.5°±5.7° vs.37.7°±5.2°.In DAA group,there was significantly less use of assistive devices [（24.6±7.8） d vs.（31.7±10.2） d,P〈0.05],and the pain was significantly lower.Harris score at the end of 6 weeks of the follow-up： in DAA group 85.7±5.4,and in PA group 81.3±6.1 （P〈0.05）;at the end of the last follow-up： in DAA group 93.4±4.7,and in PA group 92.3±5.3 （P〉0.05）.Complications were encountered in the two groups.There were two intraoperative complications （4.4%）,1 great trochanter fracture and 1 lateral cutaneous nerve injury in DAA group.No dislocation was observed in DAA group.One dislocations and 1 groin pain were recorded in PA group.No prosthesis loosening,deep vein thrombosis,sciatic nerve injury and other complications occurred in the two groups.Conclusion： Total hip arthroplasty using the anterior approach allows for superior recovery and better stability.