不同手术入路行分期双侧人工全髋关节置换术的早期疗效比较

Comparison of short-term effectiveness of staged bilateral total hip arthroplasty via different approaches

目的对分期行双侧人工全髋关节置换术患者分别采用髋关节直接前方入路(direct anterior approach,DAA)以及直接外侧入路(direct lateral approach,DLA),比较两种手术入路置换术后早期临床疗效。方法 2012年1月—2014年12月,收治32例双侧髋关节疾病患者。男20例,女12例;年龄30~67岁,平均45.3岁。股骨头缺血性坏死14例,髋关节发育不良12例,强制性脊柱炎累及双侧髋关节4例,骨关节炎2例。分期行人工全髋关节置换术,随机选取一侧采用DAA,另一侧采用DLA。比较两侧切口长度、手术时间、总失血量、术后下床活动时间及术后髋臼假体前倾角;比较两组术后髋关节Harris评分、疼痛视觉模拟评分(VAS)以及并发症发生率等。结果术后患者切口均Ⅰ期愈合。患者均获随访,随访时间20~53个月,平均39.6个月。DAA组切口长度、总失血量、术后下床活动时间均低于DLA组,但手术时间较DLA组明显延长,差异有统计学意义(P<0.05)。两组髋臼假体前倾角比较,差异无统计学意义(t=1.122,P=0.266)。DAA组及DLA组并发症发生率分别为25.00%与15.63%,差异无统计学意义(χ2=0.869,P=0.536)。术后各时间点两组Harris评分均较术前显著提高,差异有统计学意义(P<0.05);DAA组术后3、9个月时Harris评分较DLA组显著升高(P<0.05),但术后18个月两组间比较差异无统计学意义(P>0.05)。术后1、3 d及1周,DAA组VAS评分显著低于DLA组(P<0.05);术后4、8周两组间比较差异无统计学意义(P>0.05)。术后X线片复查,随访期间假体均无松动、下沉等。结论相对于DLA,采用DAA行人工全髋关节置换术具有创伤小、加快术后髋关节功能恢复等优势,早期疗效较好,但易并发股外侧皮神经损伤。

Objective To compare the short-term effectiveness of staged bilateral total hip arthroplasty via different approaches. Methods Thirty-two patients（64 hips） with bilateral hip disease were treated with total hip arthroplasty between January 2012 and December 2014. There were 20 males and 12 females with the mean age of45.3 years（range, 30-67 years）. There were avascular necrosis of femoral head in 14 cases, developmental dislocation of the hip in 12 cases, ankylosing spondylitis in 4 cases, osteoarthritis in 2 cases. All patients were treated with total hip arthroplasty; and the direct anterior approach（DAA） or direct lateral approach（DLA） was chosen for the unilateral hip randomly. The length of incision, operation time, total blood loss volume, the time of first postoperative activity, and the acetabular anteversion angle were compared. The Harris score, visual analogue scale（VAS） score, and incidence of complication were compared between 2 groups. Results All incisions healed at stage Ⅰ. All patients were followed up20-53 months（mean, 39.6 months）. The length of incision, total blood loss volume, the time of first postoperative activity were significantly shorter in DAA group than in DLA group（P0.05）. The operation time was significantly longer in DAAgroup than in DLA group（P0.05）. There was no significant difference in acetabular anteversion angle between 2 groups（t=1.122, P=0.266）. The incidence of complication were 25.00% and 15.63% in DAA group and DLA group, respectively,showing no significant difference（χ2=0.869, P=0.536）. The Harris score in DAA group significantly increased at 3 and9 months after operation than in DLA group（P0.05）; there was no significant difference at 18 months after operation between 2 groups（P0.05）. The VAS score was significantly lower in DAA group than in DLA group at 1 day, 3 days, and1 week after operation（P0.05）; there was no significant difference at 4 and 8 weeks between 2 groups（P0.05）. The prosthesis did not loosen and sink during the follow-up. Conclusion Total hip arthroplasty via DAA can reduce operation related complication and speed up the recovery of hip function at the early stage after operation. However, the lateral cutaneous nerve injury is the most common complication.