不同手术入路行全髋关节置换术对髋臼假体位置及术后早期髋关节功能影响的临床研究

Clinical study of total hip arthroplasty with different surgical approaches on the position of acetabular prosthesis and early postoperative hip function

目的探讨不同手术入路行全髋关节置换术对髋臼假体位置及术后早期髋关节功能的影响。方法 2014年5月—2016年5月绵阳市骨科医院髋关节科应用全髋关节置换术治疗126例患者,随机分为后外侧入路组和直接前入路组,各63例。比较两组患者手术时间、术中出血量、术后卧床时间、术后住院时间,以及不同时间点的VAS评分、髋臼外展角、前倾角及随访结果。结果两组手术时间比较差异无统计学意义(P>0.05);在术中出血量、术后卧床时间、术后住院时间上差异均有统计学意义(P<0.05);直接前入路组术后24、48、72h的VAS评分均显著低于后外侧入路组,术后1个月的Harris髋关节功能评分显著高于后外侧入路组,差异均有统计学意义(P<0.05);两组在髋臼外展角、前倾角及术前、术后6～24个月的Harris髋关节功能评分上差异均无统计学意义(P>0.05)。患者均获得1～2年的随访,均无严重并发症发生,假体位置良好。结论与后外侧入路对比,采用直接前入路行全髋关节置换术,在不影响髋臼假体位置的前提下,能避免肌肉损伤,获得快速髋关节功能恢复,是一种安全、可靠的手术入路,值得推广应用。

Objective To investigate the effect of total hip arthroplasty via different surgical approaches on the position of acetabular prosthesis and early postoperative hip function. Methods Totally 126 patients undergoing total hip arthroplasty were selected and randomly divided into the control group and the observation group,with 63 cases in each group. The control group was treated with posterior lateral approach, and the observation group was treated with direct anterior approach. The follow-up time was 1 to 2 years.Comparison of perioperative information,visual analog scale(VAS) scores at different time points,acetabular abduction angle,anteversion angle,and follow-up results were carried out. Results There was no significant difference in the operation time between the two groups(P>0.05);there were significant differences in intraoperative blood loss,postoperative bed rest time,and postoperative hospital stay(P<0.05);the VAS scores of the observation group at 24 h,48 h and 72 h after operation were significantly lower than those of the control group,Harris hip function score was significantly higher than that of the control group at 1 month after operation(P<0.05);there was no significant difference in hip abduction angle,anteversion angle and Harris hip function score between 6 and 24 months before and after operation(P>0.05);all patients were followed up for 1 to 2 years,no serious complications occurred and the prosthesis was in good position. Conclusion Compared with the posterolateral approach,direct anterior approach for total hip arthroplasty can avoid muscle damage and obtain rapid hip function recovery. It is a safe and reliable surgical approach without affecting the position of the acetabular prosthes, which is worth promoting.