直接前方入路与后外侧入路初次全髋关节置换术治疗股骨头坏死的早期临床疗效比较

Comparison of the early clinical effect of direct anterior approach vs. posterolateral approach for primary total hip arthroplasty in femoral head necrosis

目的比较直接前方入路(direct anterior approach, DAA)和后外侧入路(posterolateral approach, PA)行全髋关节置换术(total hip arthroplasty, THA)治疗股骨头坏死(osteonecrosis of the femoral head, ONFH)的早期临床疗效。方法回顾性分析我院2018年5月至2019年5月行THA的72例OFNH病人的临床资料,根据手术入路的不同分为PA组和DAA组,每组36例。统计病人年龄、性别、身体质量指数(body mass index, BMI)、病因及国际骨循环学会(Association Research Circulation Osseous, ARCO)分期等资料,观察比较两组病人手术切口长度、手术时间、术中出血量、术后引流量、术后下地活动时间、术后住院天数和出院时髋关节活动度等围手术期资料以及术前、术后(5 d,1、6个月)不同时间点的疼痛视觉模拟量表(visual analogue scale, VAS),采用Harris髋关节评分评价病人关节功能恢复情况。结果所有病人均获得随访,平均随访时间为6个月。DAA组的手术时间和出院时髋关节活动度明显长于PA组[(109.44±11.00)min vs.(79.81±10.16)min,166.94°±15.32°vs. 123.61°±17.47°],但其切口长度、术中出血量、术后引流量、术后下地行走时间、术后住院天数均小于PA组[(9.25±1.50)cm vs.(13.14±2.08)cm,(213.61±47.22)ml vs.(287.03±55.24)ml,(77.33±29.35)ml vs.(115.89±36.33)ml,(1.11±0.32)d vs.(1.50±0.61)d,(6.42±1.23)d vs.(8.25±1.42)d],差异均有统计学意义(P均<0.05)。DAA组术后5 d及1个月的VAS评分及Harris髋关节评分均明显优于PA组,差异均有统计学意义(P均<0.05),而术后6个月时两组的VAS评分及Harris髋关节评分的差异无统计学意义(P>0.05)。结论同PA相比,采用DAA行THA,病人术中创伤小、出血少,术后早期关节功能恢复更快、疼痛感更轻,能显著缩短病人的住院时间,从而获得较高的病人满意度。

Objective To compare the early clinical effect of direct anterior approach(DAA) vs.posterolateral approach(PA) for total hip arthroplasty(THA) in femoral head necrosis. Methods A retrospective analysis was performed on 72 patients with osteonecrosis of the femoral head(ONFH) in our hospital from May 2018 to May 2019. The patients were divided into PA group and DAA group according to the different approaches, with 36 patients in each group. General data of two groups were collected, including age,sex, body mass index(BMI), etiology and the Association Research Circulation Osseous(ARCO) staging, etc.The incision length, operation time, intraoperative blood loss, postoperative flow and postoperative walking time,postoperative hospitalization days, the hip range of motion at discharge, visual analogue scale(VAS) before and5 days, 1 month and 6 months after operation in two groups were compared. The Harris Hip Score was used to evaluate the joint function recovery. Results All the cases were followed up for 6 months. The operation time and hip motility at discharge of DAA group were significantly higher than that of PA group[(109.44±11.00) min vs.(79.81±10.16) min, 166.94°±15.32° vs. 123.61°±17.47°], the incision length, intraoperative blood loss,postoperative drainage volume, postoperative walking time and postoperative hospitalization days of the DAA group were all smaller than that of the PA group[(9.25±1.50) cm vs.(13.14±2.08) cm,(213.61±47.22) ml vs.(287.03±55.24) ml,(77.33±29.35) ml vs.(115.89±36.33) ml,(1.11±0.32) d vs.(1.50±0.61) d,(6.42±1.23) d vs.(8.25±1.42) d], all the differences are statistically significant(all P<0.05). The VAS and Harris scores in DAA group were significantly better than those in the PA group at the early stage(5 days and 1 month)(P<0.05),while there was no significant difference between the two groups at 6 th month(P>0.05). Conclusion Compared with PA, DAA for THA results in less intraoperative trauma, less bleeding, faster recovery of joint function in the early postoperative period, and less pain, which can significantly shorten the hospital stay of patients, thus achieving higher patient satisfaction.