侧卧位直接前方入路与直接外侧入路初次全髋关节置换术的比较

Direct anterior approach versus direct lateral approach in lateral decubitus position for primary total hip arthroplasty

[目的]探讨比较侧卧位直接前方入路与直接外侧入路在初次全髋关节置换中的早期临床疗效。[方法]回顾性分析2013年9月~2016年6月本院关节骨病科收治的89例(92髋)行初次全髋关节置换术患者,根据入路方式的不同分为直接前方入路(DAA)组和直接外侧入路(DLA)组,统计分析两组患者的切口长度、手术时间、术中出血量、下床行走时间、术前与术后髋关节Harris评分及并发症情况。[结果]侧卧位DAA组和DLA组切口长度分别为(9.65±0.39)cm和(12.63±0.37)cm,术中出血量分别为(125.75±11.36)ml和(220.55±12.44)ml,经统计学分析两组差异均有统计学意义(P<0.05);两组在手术时间,术中出血量,下床行走时间,术后1周、1个月、3个月的Harris评分比较,差异均有统计学意义(P<0.05);而两组假体角度、术后6个月髋关节Harris评分差异无统计学意义(P>0.05)。DAA组患者无脱位情况发生,DLA组患者1例(2.18%)发生髋关节脱位,在麻醉辅助下牵引复位获得成功;DAA组有3例(6.98%)出现股外侧皮神经损伤症状,5例(11.63%)输血;DLA组有2例(4.35%)出现大转子处疼痛,1例(2.17%)发生皮下血肿,15例(32.61%)输血。[结论]侧卧位DAA与DLA全髋关节置换比较,有出血少、脱位发生率低、下床行走时间短及术后快速康复等优势,同时侧卧位DAA全髋关节置换缩短了学习曲线。

[Objective] To compare the early clinical results of primary total hip arthroplasty （THA） through direct anterior approach （DAA） and direct lateral approach （DLA） in lateral decubitus position. [Methods] A retrospective study was performed on 89 patients （92 hips） who received primary THA from September 2013 to June 2016. Of them, 45 hips had operation performed through DAA, whereas the remaining 47 hips underwent operation through DLA. The incision length, operation time, blood loss, ambulation time and Harris hip score were recorded and compared between the two groups. [Results] Compared the DDA with the DLA, there were statistically significant differences in incision length [（9.65±0.39） cm versus （12.63±0.37） cm, P〈 0.05], and the intraoperative bleeding [（125.75±11.36） ml versus （220.55±12.44） ml, P〈0.05]. In addition, there were also statistically significant differences in the operation time, the ambulation time and Harris hip scores at lweek, 1 month and 3 months postoperatively between the two groups （P〈0.05）. However, no statistically significant difference were noticed in acetabular anteversion and abduction angle, as well as Harris score at 6 months postoperatively between the two groups （P〉0.05）. The DAA group had no dislocation in anyone of the hips, whereas the DLA group had dislocation in 1 hip, accounted for 2.1%, which successfully reduced by traction under anesthesia assistance. In the DAA group 3 patients （6.98%） had lateral femoral cutaneous nerve injury and 5 （11.63%） received blood transfusion,whereas in the DLA group, 2 patients （4.35%） got greater trochanter pain, 1 patient （2.17%）, had subcutaneous hematoma and 15 patients （32.61%） received blood transfusion. [Conclusions] The DAA for THA has obvious advantages of less bleeding, decreased incidence of dislocation, shortened ambulation time, enhanced recovery over the conventional approach of DLA. In addition, DDA in in lateral decubitus position might shorten the learning curve.