支架辅助下直接前方入路微创全髋关节置换术治疗发育性髋关节发育不良

Minimal invasive total hip arthroplasty through direct anterior approach assisted by supporting frame for treatment of developmental dysplasia of hip

目的:比较支架辅助下直接前方入路(direct anterior approach,DAA)与传统后侧入路微创全髋关节置换术治疗发育性髋关节发育不良(developmental dysplasia of hip,DDH)的临床疗效和安全性。方法:回顾性分析50例DDH患者的病例资料,其中采用支架辅助下DAA微创全髋关节置换术治疗25例(DAA组),采用传统后侧入路微创全髋关节置换术治疗25例(传统后侧入路组)。男26例,女24例。年龄39~77岁,中位数58岁。CroweⅠ型27例,CroweⅡ型23例。比较2组患者的手术时间、切口长度、术中出血量、术后引流量、术后首次下地时间和术后住院时间,以及术前和术后1周、1个月、3个月、6个月、1年、2年时2组患者的Harris髋关节功能评分,观察并发症发生情况。结果:DAA组患者的切口长度、术后住院时间和术后首次下地时间均短于传统后侧入路组[(8. 54±1. 41) cm,(13. 24±2. 45) cm,t=-8. 298,P=0. 000;(7. 31±1. 22) d,(14. 83±3. 42) d,t=-10. 364,P=0. 000;(12. 14±3. 52) h,(25. 43±5. 77) h,t=-9. 832,P=0. 000],术中出血量和术后引流量均小于传统后侧入路组[(242. 17±32. 64) m L,(361. 38±53. 28) m L,t=-9. 542,P=0. 000;(80. 43±5. 87) m L,(102. 52±8. 50) m L,t=-10. 699,P=0. 000]; 2组患者手术时间比较,差异无统计学意义[(69. 30±4. 45) min,(68. 41±5. 65) min,t=0. 623,P=0. 541]。Harris髋关节功能评分,时间因素和分组因素存在交互效应(F=4. 164,P=0. 007); 2组患者Harris髋关节功能评分总体比较,组间差异有统计学意义,即存在分组效应(F=9. 327,P=0. 048);手术前后不同时间点之间Harris髋关节功能评分的差异有统计学意义,即存在时间效应(F=31. 356,P=0. 000); 2组患者Harris髋关节功能评分随时间均呈升高趋势,但2组的升高趋势不完全一致[(41. 41±2. 43)分,(70. 59±2. 60)分,(78. 23±3. 37)分,(87. 16±4. 18)分,(92. 52±4. 76)分,(93. 14±3. 86)分,(93. 21±4. 71)分,F=17. 631,P=0. 000;(40. 73±2. 96)分,(62. 87±4. 28)分,(71. 59±2. 20)分,(82. 87±6. 33)分,(91. 04±3. 42)分,(92. 47±4. 64)分,(93. 17±3. 69)分,F=28. 382,P=0. 000];术前和术后6个月、1年、2年,2组患者Harris髋关节功能评分的组间差异均无统计学意义(t=0. 888,P=0. 379; t=1. 263,P=0. 213; t=0. 555,P=0. 581; t=0. 033,P=0. 973);术后1周、1个月和3个月,DAA组患者Harris髋关节功能评分均高于传统后侧入路组(t=7. 708,P=0. 000; t=8. 249,P=0. 000; t=2. 828,P=0. 007)。2组患者均未出现并发症。结论:与传统后侧入路微创全髋关节置换术相比,采用支架辅助下DAA微创全髋关节置换术治疗DDH,创少小,住院时间短,能使患者尽早下床锻炼,早期髋关节功能恢复快,可作为临床治疗DDH的一种较为理想的方法。但二者在手术时间和远期髋关节功能恢复方面无明显差异。

Objective:To compare the clinical curative effects and safety of minimal invasive total hip arthroplasty(THA)through direct anterior approach(DAA)assisted by supporting frame versus conventional posterior approach(CPA)for treatment of developmental dysplasia of hip(DDH).Methods:The medical records of 50 patients with DDH were analyzed retrospectively.Twenty-five patients were treated with minimal invasive THA through DAA assisted by supporting frame(DAA group),while the others were treated with minimal invasive THA through CPA(CPA group).The patients consisted of 26 males and 24 females,and ranged in age from 39 to 77 years(Median=58 yrs).The DDH belonged to Crowe typeⅠ(27)andⅡ(23).The operative time,incision length,intraoperatve blood loss,postoperative drainage,bed rest time,postoperative hospital stay and Harris hip function scores before the surgery and at 1 week,1 month,3 months,6 months,1 year and 2 years after the surgery were compared between the 2 groups,and the complications were observed.Results:The incision length,postoperative hospital stay and bed rest time were shorter and the intraoperatve blood loss and postoperative drainage were less in DAA group compared to CPA group(8.54+/-1.41 vs 13.24+/-2.45 cm,t=-8.298,P=0.000;7.31+/-1.22 vs 14.83+/-3.42 d,t=-10.364,P=0.000;12.14+/-3.52 vs 25.43+/-5.77 hrs,t=-9.832,P=0.000;242.17+/-32.64 vs 361.38+/-53.28 mL,t=-9.542,P=0.000;80.43+/-5.87 vs 102.52+/-8.50 mL,t=-10.699,P=0.000).There was no statistical difference in operative time between the 2 groups(69.30+/-4.45 vs 68.41+/-5.65 min,t=0.623,P=0.541).There was interaction between time factor and group factor in Harris hip function scores(F=4.164,P=0.007).There was statistical difference in Harris hip function scores between the 2 groups in general,in other words,there was group effect(F=9.327,P=0.048).There was statistical difference in Harris hip function scores between different timepoints before and after the surgery,in other words,there was time effect(F=31.356,P=0.000).The Harris hip function scores presented a time-dependent increasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the increasing trend of Harris hip function scores(41.41+/-2.43,70.59+/-2.60,78.23+/-3.37,87.16+/-4.18,92.52+/-4.76,93.14+/-3.86,93.21+/-4.71 points,F=17.631,P=0.000;40.73+/-2.96,62.87+/-4.28,71.59+/-2.20,82.87+/-6.33,91.04+/-3.42,92.47+/-4.64,93.17+/-3.69 points,F=28.382,P=0.000).There was no statistical difference in Harris hip function scores between the 2 groups before the surgery and at 6 months,1 year and 2 years after the surgery(t=0.888,P=0.379;t=1.263,P=0.213;t=0.555,P=0.581;t=0.033,P=0.973).The Harris hip function scores were higher in DAA group compared to CPA group at 1 week,1 month and 3 months after the surgery(t=7.708,P=0.000;t=8.249,P=0.000;t=2.828,P=0.007).No complications were found in the 2 groups.Conclusion:Minimal invasive THA through DAA assisted by supporting frame has such advantages as less trauma,shorter hospital stay,shorter bed rest time and faster hip function recovery compared to minimal invasive THA through CPA in treatment of DDH,so it can be used as an ideal therapy for treatment of DDH in clinic.However,there is no obvious difference between the two therapies in operative time and long-term hip function recovery.