两种入路行全髋关节置换术治疗股骨头缺血性坏死的短期疗效比较

Short-term effect comparison of total hip arthroplasty with two kinds of approaches for treatment of avascular necrosis of the femoral head

目的比较直接前方入路(DAA)与传统后外侧入路(PLA)行全髋关节置换术(THA)治疗股骨头缺血性坏死的短期疗效。方法92例股骨头缺血性坏死患者均行THA治疗,根据入路方式的不同将患者分为DAA组(46例,采用DAA)和PLA组(46例,采用PLA)。记录两组手术情况,术后6个月采用Harris髋关节功能评分评估疗效。结果切口长度、术中髋臼杯前倾角、术后引流量两组比较差异均无统计学意义(P>0.05)。手术时间PLA组短于DAA组,但术中出血量PLA组多于DAA组,两组2项指标比较差异均有统计学意义(P<0.05)。患者均获得6个月随访。术后6个月两组Harris髋关节功能评分优良率比较差异无统计学意义(P>0.05)。结论两种入路行THA治疗股骨头缺血性坏死的近期临床疗效相当,但PLA在保证手术疗效的同时可缩短手术时间,而DAA术中出血量更少。临床应根据患者的具体情况选择合理的手术方式。

Objective To compare the short-term effect of total hip arthroplasty(THA)via direct anterior approach(DAA)and traditional posterolateral approach(PLA)for treatment of avascular necrosis of the femoral head.Methods The 92 cases of avascular necrosis of the femoral head were treated with THA.According the different approach methods,they were divided into DAA group and PLA group,46 cases were in each group.The operative conditions of the two groups were recorded,and the therapeutic effect was evaluated by Harris hip joint function score at 6 months postoperation.Results The incision length,and the intraoperative anteversion angle of the acetabular cup,postoperative drainage volume were not statistically different between the two groups(P>0.05).The operation time of PLA group was shorter than that of DAA group,while the intraoperative blood loss of PLA group was more than that of DAA group;there were statistical differences for two indicators between two groups(P<0.05).All patients were followed up for 6 months.At 6 months after operation,there was no significant difference in the excellent-good rate of Harris hip function score between the two groups(P>0.05).Conclusions The short-term effect of THA with two approaches for avascular necrosis of the femoral head is similar,but the PLA can shorten the operation time while ensuring the operation effect,and DAA has less intraoperative blood loss.The reasonable surgical methods should be given according to the specific situation of patients.