全髋关节置换直接前入路与后外侧入路患者的早期疗效比较

Early effects of direct anterior approach versus posterolateral approach in total hip arthroplasty

背景:目前微创全髋关节置换逐渐发展成为全髋关节置换最受欢迎的手术方式,而直接前入路具有软组织损伤小、术后恢复快等优点,被称为最符合微创手术标准的全髋置换入路,但是该入路操作难度大,学习曲线长,与其他入路相比是否能取得较好的早期疗效仍存争议。目的:比较分析全髋关节置换后外侧入路和直接前入路对组织损伤及早期临床疗效的影响。方法:回顾性分析2016年10月至2017年8月在安徽医科大学第二附属医院骨科接受全髋关节置换64例患者的临床资料。根据手术入路分为直接前入路组(31例)和后外侧入路组(33例)。比较2组手术切口长度、手术时间、术中出血量、术后住院时间、术后引流量、肌酸激酶、C-反应蛋白、红细胞沉降率、白细胞介素6、疼痛目测类比评分、Harris髋关节功能评分及并发症。结果与结论:(1)与后外侧入路组相比,直接前入路组手术时间较长、术中出血较多、手术切口较短、术后住院时间较短,差异有显著性意义(P <0.05);2组术后引流量差异无显著性意义(P> 0.05);(2)直接前入路组置换后第1,2,3,4天血清肌酸激酶、C-反应蛋白、血沉、白细胞介素6水平均低于后外侧入路组(P <0.05);(3)术后24,48,72 h直接前入路组疼痛目测类比评分低于后外侧入路组(P <0.05);(4)2组患者均随访6个月,术后1,3,6个月时直接前入路组Harris髋关节功能评分均优于后外侧入路组(P <0.05);(5)2组置换后髋臼假体前倾角和外展角差异无显著性意义(P> 0.05);(6)2组置换后并发症差异无显著性意义(P=1.00);(7)综上,直接前路与后外侧入路术后随访6个月早期并发症无明显差异,相对于后外侧入路全髋关节置换,直接前方入路可获得较小的软组织创伤,较好的早期临床疗效,髋关节功能改善更佳。

BACKGROUND:Minimally invasive total hip arthroplasty is becoming the most popular procedure for total hip arthroplasty.Direct anterior approach has the advantages of small soft tissue injury and quick recovery after operation,so it is called the best approach of total hip replacement according to the minimally invasive surgical criteria.However,it is difficult to operate and the learning curve is long,and early curative effect remains controversial.OBJECTIVE:To compare the tissue injury and early clinical effect between direct anterior approach and posterolateral approach in total hip arthroplasty.METHODS:Clinical data of 64 patients undergoing total hip arthroplasty in the Department of Orthopedics,the Second Hospital of Anhui Medical University from October 2016 to August 2017,were analyzed retrospectively.The patients were divided into direct anterior approach group(n=31)and posterolateral approach group(n=33)according to the operative approach.The incision length,operation time,intraoperative blood loss,hospitalization time,drainage volume,serum creatine kinase,C-reactive protein,erythrocyte sedimentation rate,interleukin-6,Visual Analogue ScaIe score,the Harris hip score,and complications were compared between two groups.RESULTS AND CONCLUSION:(1)The direct anterior approach group showed significant longer operation time,more intraoperative blood loss,shorter incision length and shorter hospitalization time than those in the posterolateral approach group(P<0.05).The drainage volume showed no significant difference between two groups(P>0.05).(2)The levels of creatine kinase,C-reactive protein,and interleukin-6,and erythrocyte sedimentation rate at 1,2,3,and 4 days postoperatively in the direct anterior approach group were significantly lower than those in the posterolateral approach group(P<0.05).(3)The Visual Analogue Scale scores at postoperative 24,48,and 72 hours in the direct anterior approach group were significantly lower than those in the posterolateral approach group(P<0.05).(4)The Harris hip scores at 1,3 and 6 months postoperatively in the direct anterior approach group were significantly superior to those in the posterolateral approach group(P<0.05).(5)There was no significant difference in the anteversion or abduction angles of acetabular prosthesis between two groups(P>0.05).(6)The surgical complications showed no significant differences between two groups(P=1.00).(7)To conclude,there is no significant difference in 6-month complications between direct anterior approach and posterolateral approach.Direct anterior approach in total hip arthroplasty achieves less muscle damage,better early-term clinical effect and better functional recovery compared with the posterolateral approach.