平卧位直接前方入路与后外侧入路在全髋关节置换术中的临床疗效及术后VAS评分比较

Comparison of Clinical Effect and VAS Score between DirectAnterior Approach and Posterolateral Approach inSupine Position in Total Hip Replacement

目的:探讨平卧位直接前方入路与后外侧入路在全髋关节置换术中的临床疗效及术后VAS评分变化情况。方法:选取2017年1月到2019年12月我院收治的股骨头坏死患者80例,所有患者均行全髋关节置换术,根据简单随机分组法分为前方入路组和后外侧入路组各40例,前方入路组采用平卧位直接前方入路方式,后外侧入路组采用传统后外侧入路方式,比较两组患者临床疗效,观察两组患者手术相关指标,比较两组手术前后VAS评分变化、Harris评分和Barthel指数、炎症因子水平变化情况,并比较两组患者并发症发生率。结果:前方入路组总有效率(95.00%)和后外侧入路组(92.50%)总有效率差异无统计学意义(χ2=0.538,P=0.764)。前方入路组手术相关指标优于后外侧入路组,手术时间多于后外侧入路组,差异有统计学意义(P<0.05)。前方入路组术后24h、术后72h、术后1个月VAS评分均明显低于后外侧入路组(P<0.05),而术前、术后6个月两组VAS评分无明显差异(P>0.05)。手术前,前方入路组和后外侧入路组Harris评分和Barthel指数无明显差异(P>0.05);手术后两组Harris评分和Barthel指数均升高,且前方入路组升高程度更加明显(P<0.05)。前方入路组发生3例不良反应,后外侧入路组发生12例不良反应,前方入路组并发症发生率(7.50%)明显低于后外侧入路组(30.00%)(χ2=6.646,P=0.036)。结论:在全髋关节置换术入路方式中,相比于后外侧入路,直接前方入路方式可缩短手术时间和术中出血量,缓解患者疼痛,提高髋关节功能,减轻患者炎症反应,且术后并发症较少,值得临床进一步推广。

Objective:To explore the clinical effect of direct anterior approach and posterolateral approach in supine position in total hip replacement and the change of VAS score.Methods:From January 2017 to December 2019,80 patients with osteonecrosis of the femoral head in our hospital were selected.All patients underwent total hip arthroplasty.They were simply random divided into front approach group and posterolateral approach group with 40 cases each.The front approach group adopted the direct anterior approach in a prone position,and the posterolateral approach group adopted the posterolateral approach.The clinical effects of the two groups were compared and the patients in the two groups were observed The changes of VAS score,Harris score,Barthel Index and inflammatory factor level were compared before and after the operation,and the incidence of complications was compared between the two groups.Results:There was no significant difference between the two groups(χ2=0.538,P=0.764).The amount of bleeding,the length of incision,the time of descent and the time of hospitalization in the anterior approach group were less than those in the posterolateral approach group,and the operation time was more than those in the posterolateral approach group,the difference was statistically significant(P<0.05).The VAS score of the anterior approach group was significantly lower than that of the posterolateral approach group at 24 hours,72 hours and 1 month postoperatively(P<0.05),but there was no significant difference between the two groups at 6 months postoperatively(P>0.05).Before the operation,there was no significant difference in Harris score and Barthel index between the anterior approach group and the posterolateral approach group(P>0.05);after the operation,the Harris score and Barthel index of the two groups were all increased,and the degree of increase in the anterior approach group was more significant,the difference was statistically significant(P<0.05).There was no significant difference in the level of inflammatory factors between the two groups(P>0.05);the levels of IL-1,IL-6 and TNF-αin the two groups decreased 24 hours after operation,and the levels of IL-1,IL-6 and TNF-αin the front approach group were lower than those in the rear lateral approach group(P<0.05).There were 3 adverse reactions in the anterior approach group and 12 in the posterolateral approach group.The incidence of complications in the anterior approach group(7.50%)was significantly lower than that in the posterolateral approach group(30.00%)(χ2=6.646,P=0.036).Conclusion:In total hip replacement,compared with posterolateral approach,direct anterior approach can shorten the operation time and intraoperative bleeding,relieve patients'pain,improve the function of hip joint,reduce patients'inflammatory reaction,and have fewer postoperative complications,which is worthy of further clinical promotion.