前方直接入路与后外侧入路全髋关节置换术近期疗效比较

Effect Comparison on Total Hip Arthroplasty by Direct Anterior Approach and Posterolateral Approach in Short Term

目的比较前方直接入路与后外侧入路行全髋关节置换术术后近期疗效。方法 2014年2月~2016年12月选择我科诊治的股骨颈骨折患者80例,按照随机数字表法分为观察组与对照组,各40例。观察组采用直接前入路行全髋关节置换术,对照组经后外侧入路行全髋关节置换术。比较两组术后近期疗效。结果两组患者手术时间比较无统计学差异(P>0.05),但观察组切口长度、术中出血量及输血量均明显少于对照组,差异均有统计学意义(P<0.05)。术后3个月采用Harris评分评价髋关节功能:观察组优30例,良8例,可2例,优良率为95%;对照组优20例,良10例,可6例,差4例,优良率为75%;两组患者优良率比较差异有统计学意义,观察组高于对照组(P<0.05)。术后3个月观察组发生并发症3例(7.5%),包括股骨距骨折、脱位及大粗隆滑囊炎各1例,对照组并发症10例(25%),其中股骨距骨折4例,股外侧皮神经损伤3例,脱位2例,大粗隆滑囊炎1例;两组并发症率比较,观察组低于对照组,差异有统计学意义(P<0.05)。结论前方直接入路行全髋关节置换可减少手术创伤,促进髋关节功能的恢复,减少并发症的发生,从而提高近期疗效。

Objective To compare the effects of total hip arthroplasty（THA） through direct anterior approach and posterlateral approach in short term. Methods From February 2014 to December 2016,a total of80 femoral neck fracture patients in our department were randomly divided into observation group and control group according to random digits table,with 40 patients of each group. The observation group was performed THA by direct anterior approach,and the control group was carried out THA by posterlateral approach. The effects of short term were compared between two groups. Results There were no statistical difference in the operation time between the two groups（P 0. 05）,but the length of incision,the amount of blood loss and the amount of blood transfusion in the observation group were significantly less than those in the control group,and the difference was statistically（P 0. 05）. According to Harris score,the postoperative outcome was revealed30 cases of excellence,8 cases of good and 2 cases of fair in the observation group,and 20 cases of excellence,10 cases of good,6 cases of fair and 4 cases of false in the control group,and there was statistical difference in the fineness rate between two groups 3 months after the surgery（95% vs. 75%,P 0. 05）. The postoperative complication was found in 3 cases of the observation group,including one of calcar femorale fracture,dislocation and greater trochanter bursitis for each,and was in 10 cases of the control group,including 4 of calcar femorale fracture,3 of lateral femoral cutaneous nerve injury,2 of dislocation and 1 of trochanteric bursitis.The complication rate of the observation group was 7. 5%,and was lower than 25% of the control group,and the difference was statistically between two groups（P 0. 05）. Conclusion Compares with the posterolateral approach,the THA via direct anterior approach can reduce the surgical trauma,promote the recovery of hip function,decrease the complications and improve the efficacy of short term.