直接前入路髋关节置换术早期临床疗效研究

Early clinical efficacy of hip arthroplasty through direct anterior approach

目的比较采用直接前入路(DAA)与后外侧入路行髋关节置换术的早期临床疗效。方法笔者自2015-06—2016-05行髋关节置换术治疗72例髋关节疾患,其中采用DAA 32例(DAA组),采用后外侧入路40例(后外侧组)。比较2组切口长度、术中出血量、手术时间、术后下床时间、住院时间、术后Harris评分及VAS评分。结果所有患者均获随访6~12个月,平均9.3个月。DAA组手术时间较后外侧组长,住院时间、术后下地时间均较后外侧组短,差异有统计学意义(P<0.05)。术后1、3个月DAA组Harris评分高于后外侧组,差异有统计学意义(P<0.05);术后第1、3天DAA组VAS评分明显低于后外侧组,差异有统计学意义(P<0.05)。结论采用DAA行髋关节置换术可以减少创伤,减轻术后疼痛,但手术要求高,学习曲线较长。

Objective To compare the clinical effects of direct anterior approach（DAA） and posterior lateral approach in hip arthroplasty. Methods From June 2015 to May 2016, 72 patients underwent hip arthroplasty, 32 patients in direct anterior approach group（DAA） and 40 patients in posterolateral approach group（PA）. Incision length, operative time, blood loss during operation, bed rest time after operation, hospitalization stay, postoperative Harris Hip scoring and VAS scoring were compared.Results The patients had an average follow-up of 9.3（range 6-12）mouths. The operative time in DAA group was longer than that in posterolateral approach group and hospitalization stay, bed rest time in DAA group was lower than that in posterolateral approach group,there were statistical differences between two groups（P 0.05）. 1 and 3 months after surgery, there were statistical differences between two groups in Harris hip scores（HHS）（P 0.05）. 1 and 3 days after surgery, there were statistical differences between two groups in VAS（P 0.05）. Conclusion DAA hip arthroplasty could reduce soft tissue injury, reduce postoperative pain. But DAA hip arthroplasty operation needs high technical requirements and certain learning curve.