前外侧和后外侧入路全髋关节置换术的早期疗效比较

Early efficacy comparison of total hip arthroplasty via anterolateral and posteriolateral surgical approaches

目的比较前外侧和后外侧手术入路行全髋关节置换术(THA)的早期临床疗效。方法将63例行THA患者按入路不同分为两组,A组采用前外侧入路(25例),B组采用后外侧入路(38例)。观察两组患者暴露时间、切口长度、假体安装位置;记录患者术后2周、12个月HHS评分。结果患者均获得随访,时间12~24个月。暴露时间及切口长度A组均大于B组,差异均有统计学意义(P<0.05)。术后24周,两组髋臼外展角及外展角位于安全区的比例比较差异均无统计学意义(P>0.05);前倾角及前倾角位于安全区的比例、偏心距及恢复率、双下肢长度A组均优于B组,差异均有统计学意义(P<0.05)。术后12个月两组HSS评分比较差异无统计学意义(P>0.05)。结论在行THA中,后外侧入路较前外侧入路暴露时间短、手术切口小、组织暴露少;但前外侧入路能较好地保护髋关节周围肌肉组织,能够获得较快的术后康复和较好的髋关节稳定性。

Objective To compare the early clinical efficacy of total hip arthroplasty （THA） via anterolateral and posterolateral surgical approaches. Methods The 63 patients with THA were divided into two groups, 25 cases were in anterolateral approach group （group A） ,38 cases were in posterolateral approach group （group B）, comparison of two groups patients：the exposure time, incision length and prosthetic device position, patients HHS scores at 2 weeks, 12 months after surgery. Results Two groups were followed up for 12 -24 months, the exposure time, incision length of group A were longer than those of group B, the differences were statistically significant （P 〈 0. 05 ）. There was no significant difference in the abduction angle and proportion of acetabular abduction angle in the ＂safe area＂ between the two groups at 24 weeks postoperation （P 〉 0. 05 ）. The anteversion angle and ratio of anteversion angle in the ＂safe area＂ ,offset and recovery rate, length of double lower extremities of the group A were superior to group B （P〈0. 05）. There was no significant difference in HSS scores between the two groups at 12 months postoperation （ P 〉 0.05 ）. Conclusions In THA, expourse time of posterolateral approach incision is shorter than the anterolateral approach, with smaller incisions, lesser tissue exposed ; while anterolateral approach can better protect the muscle tis- sue around the hip, and achieve faster postoperative rehabilitation and better hip stability.