不同手术入路行全髋关节置换术对髋臼假体位置及术后早期髋关节功能影响的研究

Effect of total hip arthroplasty with different surgical approaches on acetabular prosthesis position and early postoperative hip function

目的探讨不同手术入路行全髋关节置换术对髋臼假体位置及术后早期髋关节功能的影响。方法选取三六三医院2018年4月—2020年4月收治的全髋关节置换术患者88例,按照电脑随机数法分为对照组和观察组,每组44例。对照组采用后外侧入路手术,观察组采用直接前入路手术。比较2组手术时间、手术出血量、术后卧床时间、住院时间以及并发症、髋臼假体位置、不同时点疼痛视觉模拟评分法(VAS)评分、术前与术后早期髋关节功能。结果观察组手术时间长于对照组,手术出血量少于对照组,术后卧床时间与住院时间短于对照组(P<0.05)。2组术后髋臼外展角与前倾角、并发症率比较,差异无统计学意义(P>0.05)。术后不同时点观察组疼痛VAS评分低于对照组(P<0.05)。术前2组髋关节功能评分比较,差异无统计学意义(P>0.05);术后1个月观察组髋关节功能评分高于对照组(P<0.05)。结论直接前入路实施全髋关节置换术治疗,相比外侧入路,虽然手术时间更长,但不会影响髋臼假体位置,且能明显减少手术出血,缓解手术疼痛,缩短术后恢复时间,促使患者髋关节功能更早改善。

Objective To investigate the effect of total hip arthroplasty with different surgical approaches on acetabular prosthesis position and early postoperative hip function.Methods A total of 88 cases of patients with total hip arthroplasty were selected from April 2018 to April 2020 in 363 Hospital,which were divided into control group and observation group according to the computer random number method,44 cases in each group.The control group was operated by posterolateral approach,while the observation group was operated by direct anterior approach.The operation time,blood loss,postoperative bed rest time,hospital stay and complications,acetabular prosthesis position,VAS score at different time points,and hip joint function before and after operation were compared between the two groups.Results The operation time of the observation group was longer than that of the control group,the amount of bleeding was less than that of the control group,and the postoperative bed rest time and hospitalization time were shorter than those of the control group(P<0.05).There was no significant difference in acetabular abduction angle,anteversion angle and complication rate between the two groups(P>0.05).VAS score of pain in observation group was lower than that in control group at different time points after operation(P<0.05).There was no significant difference in hip function score between the two groups before operation(P>0.05);the hip joint function score of observation group was higher than that of control group one month after operation(P<0.05).Conclusion Compared with the lateral approach,direct anterior approach for total hip arthroplasty treatment,although the operation time is longer,it will not affect the position of acetabular prosthesis,and can significantly reduce the operation bleeding,relieve the operation pain,shorten the postoperative recovery time,and promote the early improvement of hip joint function.