采用直接前方入路与后外侧入路行初次全髋关节置换术早期疗效比较

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

目的评价直接前方入路和后外侧入路行初次全髋关节置换术的早期临床疗效。方法回顾性分析2015年6月~2016年12月,采用人工全髋关节置换术治疗的患者54例,直接前方入路组27例,其中采用后外侧入路组27例。统计两组切口长度、手术时间、术中出血量、术后引流量、术后卧床时间、术后1个月髋关节Harris评分,假体位置及并发症情况。结果所有患者均获的随访,两组的切口长度、手术时间、术中出血量、术后引流量、术后卧床时间,差异有统计学意义(P﹤0.05);髋臼杯外展角、术后1个月髋关节Harris评分两组间比较,差异无统计学意义(P﹥0.05),直接前方入路组有1例股前外侧皮神经损伤,1例大粗隆骨折,后外侧组发生1例髋关节后脱位。结论直接前方入路具有手术切口小、术后卧床时间短,术后恢复快等优势,是可靠的手术入路,但建议术者选择熟悉的手术入路。

Objective To analyze the clinical effect of direct anterior approach and posterolateral approach in primary total hip arthroplasty.Methods From June 2015 to December 2016, 54 cases of primary total hip arthroplasty were treated, including the direct anterior approach group 27 cases （27 hips） and the posterolateral approach group 27 cases （27 hips）. The operative incision length, operative time, intraoperative bleeding, postoperative drainage volume, time of leaving bed, Harris score, Prosthasis position and complications of the two groups were observed. Rasults All patients were followed up, the incision langth, Operative time, intraoperative bleeding, postoperative drainage volume and time of leaving bed of the two group showed statistically significant （P 〈 0.05）. Acetabular abduction and postoperative Harris score showed no significant statistical differences （P 〉 0.05）. There was 1 case femoral lateral cutaneous nerve injury, 1 case with great trochanter fl^cture in the direct anterior approach group. 1 case with dislocation in posterolateral approach. Conclusion DAA hasobvions advantages of shortening the incision, quicker recovery and so on, which is safe surgical approach, But we suggest that surgeons select familiar Surgical approach.