侧卧位直接前方入路全髋关节置换手术效果分析

Analysis of the Effect of Total Hip Arthroplasty by Direct Anterior Approach in Lateral Recumbent Position

目的:探讨侧卧位直接前方入路行THA的有效性和安全性。方法:回顾性分析2017年1月-2019年8月于我院25例侧卧位直接前方入路下行THA的患者资料。统计手术切口长度、术中出血量、手术时间、髖臼假体外展角及前倾角和并发症。通过视觉疼痛评分(VAS)和髖关节功能评分(Harris)评估患者术前及术后1周、4周3个月.6个月和12个月的疼痛程度和髋关节功能。结果:切口长度为(10.3+1.8)cm;手术时间为(132.7+30.2)分钟;术中失血量为(315.8+146.3)ml。双下肢长度差异为(0.51+0.23)cm,仅1例差异为1cm。髋臼假体前倾角为14.52°+5.14°,外展角为43.54°+5.28°。1例发生术中大转子部分撕脱骨折,2例术后住院期间出现小腿肌间静脉血栓。随着随访时间推移,VAS评分明显降低.Harris评分增加。结论:侧卧位直接前方入路行THA手术安全可靠,且能够取得良好的临床效果,可以作为THA常规手术入路推广。

Objective:To explore the efficacy and safety of lateral supine direct anterior approach THA.Methods:A retrospective a-nalysis of 25 patients in our hospital with direct anterior approach to lateral THA.The operative incision length,intraoperative blood loss,operative time,external angle of acetabular prosthesis and anterior inclination angle and complications were counted.The degree of pain and hip function were assessed preoperatively and postoperatively for 1 week,4 weeks,3 months,6months and 12 months by visual pain score(VAS)and hip function score(Harris)in patients.Results:Length of incision(10.3±1.8)cm;Operation time(132.7±30.2)min;Intraoperative blood loss(315.8±146.3)ml.The difference of length between lower limbs is(0.51±0.23)cm,only one case is 1 cm.The anterior inclination of acetabular prosthesis was(14.52°±5.140)and the external angle was(43.540±5.280).One case had partial avulsion fracture of the greater trochanter during operation and two cases had intermuscular venous thrombosis of the lower leg during postoperative hospitalization.The VAS score decreased significantly and the Harris score increased with the follow-up time.Conclusion:THA operation by direct anterior approach in lateral recumbent position is safe and reliable,and can achieve good clinical results,so it can be used as a routine surgical approach for THA.