两种微创入路全髋关节置换术的近期疗效比较

Comparison of the short-term outcome of two minimally invasive approaches for total hip arthroplasty

[目的]对比微创后外侧入路(minimal invasive posterolateral approach, mi-PLA)与Bikini切口直接前方入路(Bikini incision direct anterior approach, b-DAA)行全髋关节置换术(total hip arthroplasty, THA)的短期疗效。[方法]回顾性分析2018年1月—2020年1月在本院初次行单侧THA的104例患者。根据术前医患沟通结果,52例采取mi-PLA,52例采取bDAA。比较两组围手术期指标、随访与影像资料。[结果]两组切口长度、手术时间及住院时间差异无统计学意义(P>0.05),但b-DAA组的术中出血量、术后开始直腿抬高锻炼及开始髋关节主动外展锻炼时间均优于mi-PLA组(P<0.05)。b-DAA组瘢痕面积及瘢痕OSAS评分均低于mi-PLA组(P<0.05)。术后1个月时,b-DAA组的Harris评分及髋关节活动度显著优于miPLA组。术后1、3个月,b-DAA组的OHS评分均低于mi-PLA组(P<0.05),但末次随访时两组间差异无统计学意义(P>0.05)。术后3 d复查显示,b-DAA组的LLD低于mi-PLA组,髋臼外展角及前倾角高于mi-PLA组,但差异均无统计学意义(P>0.05)。[结论] b-DAA与mi-PLA入路THA均取得良好的近期疗效,但b-DAA入路在切口瘢痕美学效果及术后早期康复训练方面更具优势。

[Objective] To compare the short-term clinical outcomes of minimal invasive posterolateral approach(mi-PLA) versus the Bikini incision direct anterior approach(b-DAA) for total hip arthroplasty(THA). [Methods] A retrospective study was conducted on 104 patients who underwent primary unilateral THA in our hospital from January 2018 to January 2020. According to the results of preoperative doctor-patient communication, 52 patients had THA performed by using mi-PLA, while the remaining 52 patients were by using b-DAA.The perioperative, follow-up and imaging data were compared between the two groups. [Results] Although there were no statistically significant differences in incision length, operation time and hospital stay between the two groups(P>0.05), the b-DDA group proved significantly superior to the mi-PLA group regarding to intraoperative blood loss, the times to begin straight leg elevation and hip active abduction exercises(P<0.05). The b-DAA group had significantly less scar area and lower scar OSAS score of the incision than the mi-PLA group(P<0.05). In addition, the b-DDA group was significantly superior to the mi-PLA group in term of Harris score and hip range of motion(ROM)at 1 month, OHS score at 1 and 3 months after operation, while which all became not statistically significant between the two groups at the latest follow-up(P>0.05). With respect to radiographic assessment at 3 days postoperatively, the b-DDA group was slightly superior to the mi-PLA group in terms of bilateral limb length discrepancy(LLD), abduction angle and anteversion of the acetabular component placed,despite of the fact that no statistically significant differences were noticed in abovesaid imaging parameters between the two groups(P>0.05). [Conclusion] Both the b-DAA and mi-PLA approaches have achieved good short-term clinical outcomes for THA. By contrast, the b-DAA approach has more advantages in term of the aesthetic effect of incision scars and early postoperative rehabilitation training.