侧卧位与仰卧位直接前入路全髋关节置换术的比较

Comparison of lateral decubitus position and supine position through direct anterior approach in total hip arthroplasty

目的比较侧卧位与仰卧位直接前入路全髋关节置换术的临床疗效,总结侧卧位直接前入路的优点及手术注意事项。方法回顾性分析自2017-01-2018-12完成的60例(60髋)初次单侧全髋关节置换术,30例选用侧卧位直接前入路手术(侧卧位组),30例选用仰卧位直接前入路手术(仰卧位组)。比较两组切口长度、手术时间、术中出血量、术后住院时间、术后第3天影像学参数、并发症情况,以及术后疼痛VAS评分与髋关节功能Harris评分。结果60例均获得随访,随访时间平均13.1(12~16)个月。侧卧位组手术时间较仰卧位组短,差异有统计学意义(P<0.05)。侧卧位组与仰卧位组切口长度、术中出血量、术后住院时间、术后影像学参数(髋臼外展角、髋臼前倾角、股骨偏心距、肢体长度差异)比较差异无统计学意义(P>0.05)。侧卧位组与仰卧位组术后1个月、6个月、末次随访时疼痛VAS评分、髋关节功能Harris评分比较差异无统计学意义(P>0.05)。结论侧卧位直接前入路全髋关节置换术的短期疗效与仰卧位直接前入路手术无明显差异,同样具有安全、有效、创伤小、快速康复的优点,而且侧卧位直接前入路不依赖特殊骨科牵引床、偏心手术器械、特殊假体就可以很好地完成手术。

Objective To compare the clinical efficacy of total hip arthroplasty through direct anterior approach in lateral decubitus position and supine position, and summarize the advantages and surgical precautions of direct anterior approach in lateral decubitus position.Methods A retrospective analysis was performed on 60 cases(60 hips) of primary unilateral total hip arthroplasty completed from January 2017 to December 2018, 30 cases were operated through direct anterior approach in lateral decubitus position(lateral position group), and 30 cases were selected in supine position direct anterior approach surgery(supine position group). The incision length, operation time, intraoperative blood loss, postoperative hospital stay, imaging parameters on the 3rd postoperative day, complications, and postoperative pain VAS score and Harris score of hip joint function were compared between the two groups.Results All 60 cases were followed up for an average of 13.1(12-16) months. The operation time of the lateral position group was shorter than that of the supine position group, and the difference was statistically significant(P<0.05). There was no statistical difference in incision length, intraoperative blood loss, postoperative hospital stay, postoperative imaging parameters(acetabular abduction angle, acetabular anteversion angle, femoral eccentricity, limb length difference) between the lateral position group and the supine position group(P>0.05). There was no significant difference in the VAS score of pain and Harris score of hip joint function between the lateral position group and the supine position group at 1 month,6 months after operation and last follow-up(P>0.05).Conclusion There is no significant difference in the short-term efficacy of total hip arthroplasty with the direct anterior approach in the lateral decubitus position and the direct anterior approach in the supine position. Total hip arthroplasty with the direct anterior approach in the lateral position also has the advantages of safety,effectiveness, less trauma and rapid recovery. As well as, without special orthopedic traction beds, eccentric surgical instruments and special prostheses, total hip arthroplasty can be completed well.