侧卧位直接前侧入路与后外侧入路在初次全髋关节置换中的早期疗效分析

Early efficacy of direct anterior approach and posterior lateral approach in primary total hip arthroplasty

目的 分析比较侧卧位直接前侧入路与后外侧入路在初次人工全髋关节置换手术中的早期临床疗效.方法 选取2016年4月至2017年4月解放军沈阳军区总医院骨科收治的初次行全髋关节置换手术（THA）的125例患者,根据其手术入路方式分为DAA组和PLA组.对所有患者随访5~11个月,平均7.2个月.统计分析两组患者的术中出血量、术后引流量、手术时间、下床行走时间、住院时间、术后髋关节Harris评分、术中及术后并发症的发生情况等.结果 DAA组患者的术中出血量和术后引流量明显少于PLA组,差异有统计学意义（P〈0.05）;DAA组住院时间明显少于PLA组,差异有统计学意义（P〈0.05）;DAA组下地行走时间明显早于PLA组,差异有统计学意义（P〈0.05）;术后关节功能采用Harris评分系统,两组患者的关节功能恢复情况差异无统计学意义（P〉0.05）.PLA组中有1例患者出现假体脱位,DAA组无髋关节脱位发生,两组并发症的发生情况比较,差异无统计学意义（P〉0.05）.结论 侧卧位直接前侧入路较后外侧入路行初次全髋关节置换在减少术中出血量、术后引流量、下地行走时间和平均住院时间等方面具有明显的优势,该手术入路安全可靠,对促进患者的术后快速康复有很大的帮助作用.

Objective To analyze and compare the early clinical effect of direct anterior approach and posterior approach in primary total hip arthroplasty（THA）.Methods A total of 125 cases of primary THA were treated,among which 65 cases used anterior approach（group DAA）,and 60 cases used posterior lateral approach（group PLA）.The follow-up period was 5 to 11months,7.2months in average.The intraoperative blood loss,operation time,postoperative drainage volume,postoperative drainage time,hospital stay,postoperative Harris score,and postoperative complications of the two groups were observed and recorded.Results Between the two groups the comparisons were as follows： blood loss and postoperative drainage volume of group DDA was significantly less than those of group PLA（P〈0.05）;hospitalization time of group DDA was significantly less than that of group PLA（P〈0.05）;ambulation time of group DDA was significantly earlier than that of group PLA（P〈0.05）;the postoperative Harris score between the two groups had no statistically significant difference（P〉0.05）.One case of false body dislocation in group PLA,no hip dislocation in group DDA,the difference of complications between the two groups had no statistical significance（P〉0.05）.Conclusion The direct anterior approach of THA has obvious advantages in less intraoperative bleeding,postoperative drainage volume,reducing ambulation time and hospitalization,and the recent curative effects are safe and reliable,which is a safe surgical approach that can benefit the rapid rehabilitation of patients.