直接外侧入路与后外侧入路对中青年全髋关节置换术后关节功能及运动恢复的影响

Effects of Direct Lateral Approach and Posterolateral Approach on Joint Function and Return to Sport after Total Hip Arthroplasty in Young and Middle-aged Adults

目的比较两种手术入路对中青年全髋关节置换术后关节功能及运动恢复情况的影响;分析国内中青年患者术后运动恢复现状,寻找延迟运动的原因。方法回顾性分析2014年1月至2018年12月期间于苏州大学附属第一医院行全髋关节置换术的151例中青年患者,按照手术入路分为两组,其中后外侧入路组81例,直接外侧入路组70例,所有患者均随访1年以上。术后随访评估Harris评分、UCLA运动评分、术后恢复运动(RTS)的发生率、RTS平均延迟时间、运动项目、未参加运动原因,并评估患者术后恢复运动的潜在预测因子。结果(1)两组患者末次Harris评分、术后UCLA运动评分、术后恢复运动百分比及恢复运动时间差异均无统计学意义(均P>0.05),但后外侧入路组患者术后1个月的Harris评分显著优于直接外侧入路组,且差异具有统计学意义(P<0.05)。(2)两组患者均未参加高剧烈程度的运动,大多数患者术后运动呈低度。(3)两组患者未恢复运动的原因主要包括担心脱位、避免磨损、疼痛等。(4)运动动机与患者的术后运动(UCLA评分)呈正相关(P<0.01)。结论直接外侧与后外侧入路均可有效改善中青年患者术后关节功能恢复,但运动恢复情况不理想,提高患者的运动动机可能有助于改善患者术后运动恢复情况。

Objective To compare the differences in postoperative joint function and the condition of returning to sport between young and middle-aged patients after total hip arthroplasty,and to analyze the status quo of postoperative return to sport in young and middle-aged patients in China and explore the reasons for their inability to return to sport.Methods A retrospective analysis was performed on 151 young and middle-aged patients who underwent total hip arthroplasty in the First Affiliated Hospital of Soochow University from January 2014 to December 2018.They were divided into two groups according to surgical approaches,including 81 cases in the posterolateral approach group and 70 cases in the direct lateral approach group.All the patients were followed up for more than 1 year.Postoperative follow-up assessments included Harris score,UCLA activity score,the incidence of returning to sport(RTS),average delay time of returning to sport,RTS items,reasons why patients cannot return to sport and the potential predictors of postoperative returning to sport in patients.Results(1)There were no statistical differences between the two groups in Harris Hip score by the last follow-up,postoperative UCLA activity score,percentage of RTS and average delay time of RTS(P>0.05),but the Harris Hip score one month after surgery was significantly higher in the posterolateral approach group than in the direct lateral approach group,and the difference was statistically significant(P<0.05).(2)None of the patients in the two groups participated in high-intensity exercise,and most of the patients showed low postoperative exercise.(3)The main reasons for patients in the two groups not RTS included fear of dislocation,avoiding wear and tear,pain and so on.(4)Motivation was positively correlated with postoperative exercise(UCLA score)(P<0.01).Conclusion Both direct lateral and posterolateral approaches are effective in improving the joint function recovery of Chinese young and middle-aged patients with total hip arthroplasty,but the condition of RTS is not ideal.In the future,improving patients’sports motivation may be helpful to RTS.