前侧入路与传统后外侧入路人工全髋关节置换术的血清学层面对比研究

A Comparative Serological Study of Direct Anterior Approach and Posterolateral Approach in Total Tip Arthroplasty

目的研究人工全髋关节置换(total tip arthroplasty,THA)直接前侧入路(direct anterior approach,DAA)与后外侧入路(posterolateralapproach,PLA)术后患者血清生物学层面的变化特点及临床意义。方法搜集潍坊医学院附属医院2015年10月至2017年3月60例初次行全髋关节置换病例,其中26例采用直接前侧入路,34例采用后外侧入路,所有患者均为单侧全髋关节置换。统计两组患者的切口长度、手术时间、术中出血量等临床资料,检测所有患者术前1天及术后第1、3、5天晨起同一时间段空腹静脉血血清C反应蛋白(C-Reactive protein,CRP)、白细胞介素-1(Interleukin-1,IL-1)、肿瘤坏死因子(tumor necrosis factor,TNF-α)、血清磷酸激酶(creatine kinase,CK)的表达水平变化。结果 DAA组与PLA组手术前后的手术时间、术中出血量、切口长度、髋臼假体外展角差异均有统计学意义(P<0.05),其余一般资料差异均无统计学意义(P>0.05);两组患者术后血清中CRP、IL-1、TNF-α的水平均较术前第1天升高,于术后3d达高峰,3d后开始下降,差异均有统计学意义(P<0.05);DAA组与PLA组患者手术前后血清中CPR、IL-1、TNF-α、CK水平随时间变化的趋势大致相同,但DAA组术后IL-1、TNF-α、CK水平明显低于PLA组。结论全髋关节置换术后3d患者血清中CRP、IL-1、TNF-α及CK水平达到高峰,提示全髋关节置换术后3d是抗炎治疗的关键时期;IL-1、TNF-α、CK在DAA组表达水平较低,提示DAA较PLA拥有着更小的软组织损伤,术后急性无菌性炎症反应程度更低,并且DAA切口长度短、手术时间短、术中出血量少,DAA治疗效果优于PLA。

Objective To investigate the changes and clinical significance of serum levels in patients between direct anterior approach（DAA）and posterolateral（PLA）in total tip arthroplasty（THA）.Methods 60 cases of total hip arthroplasty were collected from October 2015 to March 2017 inWeifang medical university affiliated hospital,26 cases underwent THA throughdirect anteroposterior approach,34 cases underwentTHA through posterior lateral approach.All patients were primary unilateral total hip arthroplasty.The general clinical data and incision length,operation time and intraoperative blood loss were collected from the two groups and fasting venous blood was collected in the morning.The contents of CRP,IL-1,TNF-α,CK in blood serum were detected on the day before operation and 1,3,5 days on the first day and the first day after operation.Results The operative time,intraoperative blood loss,incision length,and acetabular prosthesis aberrations were significantly different between the DAA group and the PLA group（P〈0.05）,the rest of the general data showed no significant difference（P〉0.05）.The levels of CRP,IL-1 and TNF-αin the serum of the two groups were higher than those before the first day,and reached the peak at 3 days after operation.The difference was statistically significant（P〈0.05）.The changes of serum levels of CPR,IL-1,TNF-α,CK in the group DAA and group PLA were similar over time,but the levels of IL-1,TNF-αand CK in the DAA group were significantly lower than those in the group PLA.Conclusion The levels of CRP,IL-1,TNF-αand CK in the serum of patientsachieved the highest on the third day after operation,which suggests that 3 daysafter operation is the critical period for anti-inflammatory treatment after total hip replacement.The levels of IL-1,TNF-and CK in DAA group were lower,suggesting that DAA has less soft tissue injury than PLA,and the rate of acute aseptic inflammation is lower.Moreover,DAA incision has shorter length,shorter operation time and less bleeding during operation.DAA treatment is superior to PLA.