直接前方入路与后外侧入路全髋关节置换术的疗效比较

A Comparative Study on the Clinical Outcomes between Total Hip Arthroplasty by Anterior Approach and Posterior Approach

目的探讨直接前方入路(direct anterior approach,DAA)和后外侧入路(posterior approach,PA)行全髋关节置换术的临床疗效。方法按照纳入排除标准选择我院2013年12月至2016年6月行全髋关节置换术的所有病例,共有128例,分为DAA组(57例)和PA组(71例)。对比分析两组患者手术时间、出血量、下地时间、住院时间,术前、术后1个月及随访时的视觉模拟评分(visual analog scale,VAS)及Harris评分;测量术后髋臼假体的前倾角及外展角,记录术后并发症发生情况。结果 DAA组出血量(232.4±28.6)mL低于PA组出血量(382.3±37.5)mL,DAA组下地时间(1.8±0.7)d低于PA组下地时间(4.3±2.1)d,DAA组住院时间(7.4±1.9)d低于PA组住院时间(9.2±2.3)d,差异均有统计学意义(P<0.05)。而DAA组的手术时间(112.2±12.6)min长于PA组(98.4±10.3)min,差异有统计学意义(P<0.05)。DAA组术后1个月VAS评分为(2.3±0.9)分,Harris评分(84.3±4.2)分;PA组术后1个月VAS评分为(2.9±1.3)分,Harris评分(80.6±6.5)分;DAA组优于PA组,差异有统计学意义(P<0.05)。而随访时DAA组的VAS评分为(1.5±0.8)分,Harris评分(92.2±5.3)分;PA组VAS评分为(1.3±1.1)分,Harris评分为(90.5±6.8)分,两组比较差异无统计学意义(P>0.05)。DAA组术后假体前倾角(21.3±3.3)°,外展角(39.8±5.4)°;PA组术后假体前倾角(20.6±4.3)°,外展角(41.3±5.0)°,两组比较差异无统计学意义(P>0.05)。结论直接前方入路全髋关节置换术具有手术出血量小、下地时间早、住院时间短、术后疼痛较轻、假体位置良好等优点,短期临床疗效与后外侧入路均较为满意,长期临床疗效还需进一步随访研究。

Objective To further compare the clinical outcomes of total hip arthroplasty（THA）through direct anterior approach（DAA）and posterior approach（PA）Methods We selected the consecutive cases of THA of our hospital from December 2013 to June 2016 according to the inclusion and exclusion criteria.All the 128 cases was divided into DAA group（57 cases）and PA group（71 cases）.And the mean follow-up was 19.6 months.The operative time,blood loss,the leaving bed time,hospital stay,visual analog scale（VAS）and Harris score before operationwere recorded and analyzed.Meanwhile the acetabular anteversion angle and acetabular abduction angle were measured and analyzed.The postoperative complications were recorded.Results The blood loss of the DAA group（232.4±28.6）mL was shorter than the PA group（382.3±37.5）mL（P〈0.05）;the leaving bed time of the DAA group（1.8±0.7）d was shorter than the PA group（4.3±2.1）d（P〈0.05）;the hospital stay of the DAA group was（7.4±1.9）d was shorter than the PA group（9.2±2.3）d（P〈0.05）.However,the operative time of the DAA group（112.2±12.6）min was longer than the PA group（98.4±10.3）min（P〈0.05）.The VAS score of the DAA group（2.3±0.9）w as lower than the PA group（2.9±1.3）at one month（P〈0.05）,the Harris score of the DAA group（84.3±4.2）was higher than the PA group（80.6±6.5）at one month（P〈0.05）.The VAS score was（1.5±0.8）in DAA group and（1.3±1.1）in the PA group.The Harris score was（92.2±5.3）in DAA group and（90.5±6.8）in the PA group,which showed no significant difference between the two groups（P〉0.05）.The acetabular anteversion angle was（21.3±3.3）° in DAA group and（20.6±4.3）° in the PA group.The acetabular abduction angle was（39.8±5.4）° in DAA group and（41.3±5.0）° in the PA group,which showed no significant difference between the two groups（P〉0.05）.Conclusion Direct anterior approach of THA has less blood loss,earlier get out of the bed,shorter hospital stays less pain and good position of acetabular prosthesis while comparing with PA group.The clinical outcomes are satisfactoryat about 20 months,however,the longer results needed longer follow up studies.