两种手术入路行初次全髋关节置换术的近期疗效对比

Comparison of Early Effect between Primary Total Hip Arthroplasty through Two Approaches

目的比较后外侧入路(posterolateral surgical approach,PSA)与前外侧入路(anterolateral surgical approach,ASA)行初次全髋关节置换术(total hip arthroplasty,THA)的近期疗效。方法我院2012年2月至2015年2月间行初次全髋关节置换病例140例,经PSA行初次THA76例,其中男34例,女42例,年龄62~78岁,平均68.5岁。经ASA行初次THA64例,其中男33例,女31例,年龄50~79岁,平均70.5岁。对两组病例的切口长度、手术时间、术中出血量及术后引流量、术后下地时间、住院时间进行比较,并采用髋关节Harris评分量表评定两组患者术前、术后6个月及末次随访时髋关节功能,观察两组患者术后并发症的发生情况。结果术后随访10~48个月,平均25.5个月。PSA组出现1例迟发型感染,于初次置换术后18个月行翻修手术;2例术后出现假体脱位,均手法复位成功。ASA组术后无感染及脱位发生。两组术中出血量及术后引流量比较,差异无统计学意义(P>0.05)。两组切口长度、手术时间、术后下地行走时间、住院时间比较,差异有统计学意义(P<0.05)。PSA组术前Harris评分(42.43±7.25)分,术后6个月(87.90±7.36)分,术后末次随访(90.30±8.24)分;ASA组术前Harris评分(41.72±6.98)分,术后6个月(90.20±8.05)分,术后末次随访(92.50±9.20)分。两组比较差异无统计学意义(P<0.05)。结论采用PSA及ASA行初次THA均能取得令人满意的近期疗效。同PSA相比,ASA的手术切口长度及手术操作时间相对较短,患者术后可以早期下地,减少卧床并发症,缩短住院病程,并且在预防术后髋关节假体脱位方面存在较明显的优势。

Objective To compare the early clinical effects of anterolateral and posterolateral surgical approaches in primary total hip arthroplasty（THA）.Methods Between February 2012 and February 2015,76 cases of primary THA were treated by posterolateral surgical approache （PSA）.Among them,there were 34 males and 42 females,aged 62 to 78 years with an average of 68.5 years. Another 64 cases of primary THA were treated by anterolateral surgical ap- proache（ASA） at the same period.Among them,there were 33 males and 31 females,aged 50 to 79 years with a mean of 70.5 years.Incision length, operation time, blood loss, postoperative lead flow, time to exercise and postoperative hos- pitalization time were analysed and compared between two groups.The Harris hip score was used to evaluate and com pare hip functions and complications before operation, 6 months after operation and the latest follow up between two groups.Results All the patients were followed up and the duration ranged from 10 to 48 months （averaged 25.5 months）.l case in PSA group had delayed infection and received revision 18 months after primary THA.2 cases disloca- tion were observed in PSA group and underwent manipulative reduction.There was no infection and dislocation case in ASA group.There were no significant differences of the blood loss volume and the postoperative drainage between the two groups（P〉0.05）.But the operation time , the incision length ,the time to exercise and the postoperative hospitali- zation time of the PSA group were longer than the ASA group （P〈0.05）.No significant difference was found in the Harris score between the two groups before operaiton [PSA group（42.43±7.25）,ASA group （41.72±6.98）,P〉 0.05] ,6 months after operation [PSA group（87.90±7.36） ,ASA group （90.20±8.05） ,P〉0.05]and the last follow up [PSA group（90.30±8.24） ,ASA group （92.50±9.20） ,P〉0.05].Conclusion Primary THA through the two approa- ches（PSA and ASA） can achieve favorable short-term effectiveness.Compared with THA through PSA,THA through ASA need a relatively short operation time and with a relatively small incision.The patients can get out of bed earlier, thus reduce the complications and shorten the hospitalization time. It has advantage about prevention of postoperative dislocation.