直接前方入路髋关节置换术的初期与后期病例疗效对比分析

Comparative Analysis of the Efficacy of Early and Late Cases of Hip Replacement by Direct Anterior Approach

目的对比分析直接前方入路(direct anterior approach,DAA)行髋关节置换术的初期和后期病例的短期临床疗效,探讨DAA髋关节换术学习曲线。方法 2016年10月至2017年11月,对106例患者采用DAA行初次髋关节置换(其中股骨头坏死36例36髋,髋关节骨性关节炎17例17髋,髋关节发育不良11例11髋,强直性脊柱炎髋关节病变1例1髋,股骨颈骨折41例41髋),前50例为初期组,后56例后期组,进行回顾分析,分别对切口长度、手术时间、术中出血量、伤口引流量、输血率、术后假体位置、脱位率、并发症及术后1个月和3个月VAS评分、Harris评分等进行记录和测量。结果在手术时间,术中出血量,伤口引流量,髋臼杯前倾角上,后期组均优于初期组(P <0. 01),髋臼外展角无明显差异,两组均无后脱位,术后1月Harris评分后期组优于初期组,术后3个月两组无差别(P> 0. 05)。结论直接前方入路髋关节置换术有一定的学习曲线,50例以后在手术时间、出血量、并发症、假体位置等方面会有明显改善。

Objective To compare the short-term clinical outcomes of early and late cases of direct anterior approach( DAA) for hip arthroplasty,and to explore the learning curve of DAA hip arthroplasty. Methods From October 2016 to November 2017,clinical data of 106 patients( 36 cases with femoral head necrosis,17 cases with hip osteoarthritis,11 cases with dysplasia of the hip,1 case of ankylosing spondylitis,41 cases of femoral neck fractures) treated with THA through a direct anterior approach was retrospectively analyzed.The first 50 cases belonged to the initial group,and the latter 56 cases belonged to the late group. The incision length,operation time,intraoperative blood loss,wound drainage,blood transfusion rate,postoperative prosthesis position,dislocation rate and complications were performed. The VAS score and Harris score were recorded and measured. Results It was proved that operation time,intraoperative blood loss,wound drainage and acetabular cup anteversion angle of the late group were superior to the initial group( P < 0. 05),and there was no significant difference in acetabular abduction angle( P > 0. 05). There was no dislocation in both groups.The 1-month Harris score of the late group was superior to the initial group( P < 0. 05),but there was no difference after 3 months. Conclusion Direct anterior approach hip arthroplasty has a certain learning curve,and after 50 cases of practice,it will have significant improvement in operation time,bleeding volume,complication rates,and position of the prosthesis.