直接前入路与后外侧入路全髋关节置换术的早期疗效比较及术后持续疼痛危险因素分析

Comparison of the early efficacy between direct anterior approach and posterolateral approach in total hip arthroplasty and analysis of the risk factors of postoperative persistent pain

目的:比较直接前入路(DAA)与后外侧入路(PLA)全髋关节置换术的早期疗效,并对发生术后持续性疼痛危险因素进行分析。方法:回顾性分析100例全髋关节置换术后病人资料,按手术方式分为DAA组(40例)和PLA组(60例)。比较2组手术切口长度,手术时间,术中出血量,术后第1天血红蛋白下降值,术后至下床时间,术后住院时间,术后1、3、5 d疼痛VAS评分,术后1、3、6个月髋关节功能Harris评分以及相关并发症的发生情况,其中出现术后持续疼痛的30例病例作为进一步研究对象,进行相关风险因素分析。结果:100例均获得6个月以上随访。与PLA组比较,DAA组切口长度更短,术后至开始下床时间与术后住院时间更短,术后1、3、5 d疼痛VAS评分更低,术后1、3个月髋关节功能Harris评分更高,差异均有统计学意义(P<0.05)。2组手术时间、术中出血量、术后第1天血红蛋白下降值、术后6个月髋关节功能Harris评分比较差异均无统计学意义(P>0.05)。多因素logistic分析结果显示年龄小、体质量指数高和手术时间长是影响初次髋关节置换术后持续疼痛的独立危险因素(P<0.01)。结论:与PLA手术比较,DAA全髋关节置换术具有切口显露创伤小、术后疼痛轻、下床活动时间早、术后早期髋关节功能恢复更快的优点,尤其是在病人自我感觉恢复方面更具有优势。年龄<60岁、体质量指数>26 kg/m~2、手术时间>1 h是初次髋关节置换术后持续性疼痛的危险因素。

Objective:To compare the early efficacy between direct anterior approach(DAA) and posterolateral approach(PLA) in total hip arthroplasty,and analyze the risk factors of postoperative persistent pain.Methods:The clinical data of 100 patients treated with total hip arthroplasty were retrospectively analyzed,and the patients were divided into the DAA group(40 cases) and PLA group(60 cases).The length of incision,operation time,intraoperative blood loss,haemoglobin decrease on the first day after operation,postoperative time to get out of bed,postoperative hospital stay,VAS score of pain after 1,3 and 5 days of operation,Harris score of hip joint function after 1,3 and 6 months of operation,and occurrence of related complications were compared between two groups.The risk factors in 30 patients with postoperative persistent pain were further analyzed.Results:One hundred cases were followed up for more than 6 months.Compared with the PLA group,the incision length was shorter,the postoperative time to get out of bed and hospital stay were shorter,the VAS score after 1,3 and 5 days of operation were lower,and the Harris score after 1 and 3 months of operation were shorter in the DAA group(P0.05).The results of multivariate logistic analysis showed that the younger age,higher body mass index and longer operative time were the independent risk factors of persistent pain after primary hip arthroplasty(P26 kg/m~2 and operation time >1.0 h are the risk factors of persistent pain after primary hip arthroplasty.