直接前入路微创全髋关节置换的有效性与安全性分析

The effectiveness and safety of direct anterior approach in minimally invasive total hip arthroplasty

目的:研究直接前入路微创全髋关节置换的治疗效果并对有效性和安全性做出分析,旨在为全髋关节置换患者提供最优手术解决方案。方法:选取2014年2月~2016年1月入住我院骨科治疗的明确诊断需要行全髋关节置换患者80例,随机将患者分为观察组(40例)和对照组(40例),所有患者给予术前患肢固定等统一的基础治疗方案。观察组采用直接前入路微创手术,对照组给予后外侧入路手术。对两组患者手术切口长度、术中出血、术中输血量等一般情况、术后6周、3个月、6个月行Harris髋关节功能评分,组间比较采用t检验、以及术中术后的并发症评价采用SPSS 21.0软件行方差分析做出统计,综合评价直接前入路微创全髋关节置换术的疗效和可行性。结果:观察组患者在术中切口长度、手术时间、术中出血量和输血量等方面和对照组比较有显著性差异(P<0.05);两组患者术后术后6周Harris髋关节功能评分有显著性差异(P<0.05);3个月和6个月Harris髋关节功能评分的比较无显著性差异(P>0.05);两组患者术后并发症的发生率比较有显著性差异(χ~2=4.50,P<0.05)。结论:直接前入路微创全髋关节置换术在患者术中术后近期6周疗效优于后外侧入路组,这有利于患者早期恢复,6周后观察疗效和后外侧入路组相当,值得在临床中推广应用。

Objective： To study the effectiveness and safety of direct anterior approach in minimally invasive total hip arthroplasty,and to provide the optimal surgical solution for total hip replacement. Methods： from February 2014 to January 2016 in our hospital department of orthopedics diagnosis in treatment of 80 patients undergoing total hip replacement patients were randomly divided into observation group（ 40 cases） and control group（ 40 cases）,all patients were given basic treatment of limb fixation uniform before operation. The observation group was treated by direct anterior approach,and the control group was treated with posterior lateral approach. The two groups of patients with surgical incision length,intraoperative blood loss,blood transfusion and other general conditions,after 6 weeks,3 months and 6 months Harris hip joint function score were compared by t test,and the postoperative complications of evaluation and analysis using SPSS 21 software for variance statistics comprehensive evaluation,effect and feasibility of direct anterior approach of minimally invasive total hip replacement. Results： the observation group patients in the intraoperative incision length, operative time, intraoperative bleeding and transfusion,and the control group with significant difference（ P〈0. 05）; there was significant difference in Harris scores at 6 weeks hip joint function after operation in the two groups after operation（ P〈0. 05）; 3 months and 6 months Harris hip score and there is no significant difference（ P〈0. 05）; two groups of patients with postoperative complications had significant difference（ χ~2= 4. 50 P〈0. 05）. Conclusion： minimally invasive total hip arthroplasty in patients with postoperative posterolateral approach group,which is conducive to the early recovery of patients,6 weeks after the observation of curative effect and posterolateral approach group,it is worth in clinical application.