直接前入路髋关节置换前100例并发症分析

A analysis of complications in the first 100 cases with hip arthroplasty by the direct anterior approach

目的探讨早期学习直接前入路(direct anterior approach,DAA)并发症的发生情况。方法回顾性分析2014年6月至2016年2月,本院行DAA髋关节置换前100例患者的资料,其中全髋关节置换术(total hip arthroplasty,THA)共59例(68髋),半髋关节置换术(hip hemiarthroplasty,HHA)41例(41髋)。疾病种类:股骨颈骨折61例,股骨头坏死19例,髋关节炎20例;其中男31例,女69例,年龄43~95岁,平均(71±12)岁。嘱患者术后1、3、6、12个月门诊回访,之后每年随访1次。结果 88例获6~22个月的随访,平均(15±5)个月。住院时间5~22天,平均(13±4)天,手术时间THA(108±25)min,HHA(80±15)min;失血量THA(388±78)ml,HHA(119±45)ml。股外侧皮神经(lateral femoral cutaneous nerve,LFCN)损伤20例,大转子撕脱骨折2例,股骨距骨折2例,髋臼骨折1例,大转子切割2例,股前痛23例,术后脱位1例,切口浅表感染2例,切口血肿形成2例,下肢不等长9例。未发生深部感染、严重骨水泥反应及深静脉血栓形成。末次髋关节Harris评分THA(91±23)分;HHA(89±19)分。结论 DAA髋关节置换术学习曲线陡峭,早期并发症发生率较高,但通过经验的积累,并发症发生率会明显降低。

Objective To discuss the complications of direct anterior approach （ DAA ） in the early experience to help the beginners to shorten the learning curve and assist patients in getting better results. Methods We retrospectively analyzed the data of first 100 patients with hip arthroplasty by DAA from June 2014 to February 2016 in our hospital. There were 59 patients （ 68 hips ） in total hip arthroplasty （ THA ） and 41 patients （ 41 hips ） in hip hemiarthroplasty （ HHA ）. Classification of diseases： 61 cases were of femoral neck fracture, 19 cases of femoral head necrosis, 20 cases of hip arthritis. There were 31 males and 69 females with the mean age of（ 71 ± 12 ） years （ range： 43 - 95 years ）. The patients were required to have a regular follow-up at 1 month, 3 months, 6 months and 12 months after operations, and then followed up once a year. Results There were 88 patients followed up for （ 15 ± 5 ） months （ range： 6 - 22 months ）. The mean length of stay was （ 13 ±4 ） days （ range： 5 - 22 days ）. The average duration of THA was （ 108 ± 25 ） min and the average HHA was （ 80 ± 15 ） min. The blood loss was THA （ 388 ± 78 ） ml and HHA （ 119 4. 45 ） ml. There were 20 cases of lateral femoral cutaneous nerve （ LFCN ） injury, 2 cases of large trochanter avulsion fracture, 2 cases of femoral fracture, 1 case of acetabular fracture, 2 cases of large trochanteric incision, 23 cases of pre-femoral pain, 1 case of dislocation, 2 cases of incision superficial infection, 2 cases of incision hematoma formation, 9 cases of unequal length of both lower limbs. There were no deep infection, severe bone cement reaction or DVT in our cases. The hip Harris scores were （ 91 ± 23 ） for THA and （ 89 ± 19 ） for HHA. Conclusions DAA has a long learning curve and a high rate of complications in early stage but the incidence of complications will be significantly reduced with the accumulation of experience.