侧卧位直接前路全髋置换术治疗非创伤性股骨头坏死的近期疗效分析

Short-term efficacy of lateral direct anterior approach total hip arthroplasty in the treatment of non-traumatic osteonecrosis of femoral head

为探究侧卧位直接前路(lateral direct anterior approach,LDAA)全髋关节置换术(total hip arthroplasty,THA)治非创伤性股骨头坏死(osteonecrosis of femoral head,ONFH)的近期疗效,本文分析2017 年1 月至6 月采用LDAATHA治疗的非创伤性ONFH 患者120 例(125 髋),男64 例(66 髋),女56 例(59 髋)。髋关节功能评估采用Harris 评分,疼痛评估采用疼痛视觉模拟评分(VAS 评分),影像学评估假体位置及假体的稳定性,住院期间记录患者住院时间及血管神经损伤、下肢血栓、心脑血管事件等并发症发生率,随访时观察术后伤口愈合情况,有无脱位、异位骨化及假体周围感染等并发症发生。结果表明侧卧位直接前方入路人工全髋关节置换术治疗非创伤性股骨头坏死可以获得满意的近期疗效,患者术后关节功能明显改善,并发症发生率低,但远期疗效仍需进一步随访。

To explore the short-term efficacy of lateral direct anterior approach total hip arthroplasty in the treatment of nontraumatic osteonecrosis of femoral head. 120 patients (125 hips), 64 males (66 hips) and 56 females (59 hips) with non-traumatic osteonecrosis of femoral head treated by LDAA-THA from January to June 2017 were analyzed. There are 28 cases(28 hips) classificated as Ficat stage Ⅲ and 92 cases(97 hips) classificated as Ficat stage Ⅳ. Harris score was used for hip joint function evaluation, and visual analogue scale was used for pain evaluation. Imaging evaluation included prosthesis position and prosthesis stability. During hospitalization, the duration time, the incidence of neurovascular injury, lower limb thrombosis, cardiovascular and cerebrovascular events and other complications were recorded. Postoperative wound healing was observed during followup. The occurrence of complications such as dislocation, heterotopic ossification and periprosthetic joint infection were observed. The results shows that total hip arthroplasty through lateral direct anterior approach for the treatment of non-traumatic osteonecrosis of femoral head can achieve satisfactory short- term efficacy, with significant improvement of postoperative joint function and low incidence of complications, but its long-term outcomes still need be explored by further studies.