小切口后方入路和直接外侧入路全髋关节置换临床疗效比较

Comparison of Clinical Curative Effect of Total Hip Arthroplasty Through Small Incision Posterior Approach and Direct Lateral Approach

目的探讨小切口后方入路与直接外侧入路在全髋关节置换术中的应用效果。方法择取2017年1月—2018年9月上海瑞金医院骨科80例全髋关节置换手术病例,随机均分为观察组(小切口后方入路手术,40例)和对照组(直接外侧入路手术,40例)。比较观察两组基本治疗指标,随访评价两组术后疼痛与髋关节功能恢复情况,统计并发症。结果两组术后髋关节复位与功能基本相当,均未见严重并发症。观察组手术切口长度(10.2±0.6)cm短于对照组(13.7±1.2)cm,显性失血量(260±55)mL少于对照组(350±80)mL,术后24 h休息时NRS评分(1.8±0.4)分低于对照组(2.7±0.7)分,活动时NRS评分(3.3±1.2)分低于对照组(4.8±0.9)分,差异有统计学意义(t=3.372、9.425、3.062、3.145,P<0.05)。结论以小切口后方入路和直接外侧入路行全髋关节置换均效果确切、安全可行,其中前者手术创伤小,术中出血少,疼痛反应轻,利于早期康复,更具临床优势,值得推广使用。

Objective To explore the effect of small incision posterior approach and direct lateral approach in total hip arthroplasty.Methods From January 2017 to September 2018,80 cases of total hip replacement surgery in the Department of Orthopedics of Shanghai Ruijin Hospital were selected and randomly divided into observation group(small incision posterior approach surgery,40 cases)and control group(direct lateral approach,40 cases).The basic treatment indicators of the two groups were compared and observed.The postoperative pain and hip function recovery of the two groups were evaluated by follow-up,and the complications were counted.Results The reduction and function of hip joints in the two groups were basically the same after operation,and there were no serious complications.The length of the surgical incision in the observation group was(10.2±0.6)cm shorter than that in the control group(13.7±1.2)cm,the apparent blood loss(260±55)mL was less than the control group(350±80)mL,and the NRS score was at rest 24 hours after surgery(1.8±0.4)points lower than the control group(2.7±0.7)points,and the NRS score during activity(3.3±1.2)points was lower than the control group(4.8±0.9)points,the difference was statistically significant(t=3.372,9.425,3.062,3.145,P<0.05).Conclusion Both the small-incision posterior approach and the direct lateral approach for total hip arthroplasty are effective,safe and feasible.The former has less surgical trauma,less intraoperative bleeding,and mild pain response,which is beneficial to early rehabilitation and has more clinical advantages.It is worthy of promotion use.