侧卧位直接前入路微创全髋置换术的短期临床疗效评价

Evaluation of short term clinical effect of minimally invasive total hip arthroplasty with direct anterior approach in lateral position

目的:探讨侧卧位直接前入路(direct anterior approach,DAA)微创全髋关节置换术(total hip arthroplasty,THA)的短期临床疗效。方法:对2018年1月至2018年9月由同手术团队完成的侧卧位DAA行初次THA的30例(33髋)患者资料进行随访评价,男19例,女11例;年龄58~80(69.0±5.4)岁;分别从疼痛视觉模拟评分(visual analogue scale,VAS),Harris评分系统,手术时间,术中出血量,相关并发症以及髋关节正位X线片进行临床和影像学方面的评价。结果:30例(33髋)患者均获得随访,时间12~20(14.3±3.7)个月,手术时间(66.0±7.2)min,术中出血量(156±32)ml。术后影像学检查髋臼假体位置:前倾角(18.6±3.6)°,外展角(41.2±4.8)°。VAS评分由术前7~9(8.1±1.4)分改善为术后1个月1~3(1.9±0.7)分。髋关节Harris评分显著改善,由术前28~46(35.4±5.2)分改善为术后1个月76~92(88.6±4.5)分,术后6个月74~93(85.6±6.9)分,术后12个月79~95(90.7±8.1)分,差异有统计学意义(P<0.05)。并发症:发生3例股骨近端裂纹骨折,其中1例术后1个月行走不慎髋部扭伤骨折,考虑术中可能已经发生不完全骨折,1例发生髂前下棘撕脱骨折,无深部感染及脱位发生。股外侧皮神经损伤1例,阔筋膜张肌损伤2例,其中1例为拉钩边缘完全切割伤。结论:运用侧卧位DAA行初次THA具有良好的近期临床疗效,能够满足患者快速康复的需要,是一种安全有效的手术入路。

Objective:To investigate the short term clinical effect of direct anterior approach(DAA)in total hip arthroplasty(THA).Methods:From January 2018 to September 2018,the data of 30 patients(33 hips)who underwent the first THA using the side lying DAA completed by the same operation team were followed up and evaluated.There were 19 males and 11 females;the age was 58 to 80(69.0±5.4)years old;the visual analogue scale(VAS)of pain was used,Harris scoring system,operation time,intraoperative blood loss,related complications and hip radiographs were evaluated in clinical and imaging aspects.Results:Thirty patients(33 hips)were followed up for 12 to 20(14.3±3.7)months,operation time(66.0±7.2)min and intraoperative hemorrhage(156±32)ml.The position of acetabulum prosthesis was examined by imaging:anteversion angle(18.6±3.6)°and abduction angle(41.2±4.8)°respectively.The VAS score was improved from 7 to 9(8.1±1.4)before operation to 1 to 3(1.9±0.7)at 1 month after operation.Harris score of hip joint improved significantly,from 28 to 46(35.4±5.2)before operation to 76 to 92(88.6±4.5)at 1 month after operation,74 to 93(85.6±6.9)at 6 months after operation,and 79 to 95(90.7±8.1)at 12 months after operation,the difference was statistically significant(P<0.05).Complications occurred in 3 cases of fracture of the proximal femur,including 1 case of hip sprain fracture due to careless walking one month after operation.Considering that incomplete fracture may have occurred during the operation,1 case of avulsion fracture of anterior inferior iliac spine,no deep infection,no dislocation.There were 1 case of injury of lateral femoral cutaneous nerve and 2 cases of injury of tensor fascia lata,among which 1 case was complete incision of the edge of the hook.Conclusion:The primary THA with DAA in lateral position has a good short;term clinical effect,can meet the needs of patients’rapid recovery,and is a safe and effective surgical approach.