直接前方入路与后外侧入路在全髋关节置换术中的应用效果比较

Comparison on application effects of direct anterior approach and posterolateral approach in total hip arthroplasty

目的比较直接前方入路与后外侧入路在全髋关节置换术(THA)中的应用效果,为THA手术入路的选择提供依据。方法选择洋县人民医院骨科于2018年2月至2021年2月期间收治的80例拟接受THA治疗的患者为研究对象,根据随机数表法分为观察组和对照组,每组40例,对照组患者手术选择后外侧入路,观察组患者则选取直接前方入路,比较两组患者的手术相关临床指标、术后的疼痛视觉模拟评分(VAS)、术后髋关节Harris评分以及随访6个月时并发症的发生情况。结果观察组患者的手术切口长度和住院时间分别为(7.39±1.10)cm、(6.10±2.18)d,明显短于对照组的(8.22±1.47)cm、(7.87±2.32)d,手术时间和术中出血量分别为(87.10±11.38)min、(143.90±32.75)mL,明显长(多)于对照组的(76.22±9.06)min、(125.16±28.04)mL,差异均有统计学意义(P<0.05);术后1 d,观察组患者VAS评分为(3.76±1.12)分,明显低于对照组的(4.32±1.08)分,差异有统计学意义(P<0.05);术后1个月,两组患者的VAS评分比较差异无统计学意义(P>005);术后1个月,观察组患者的髋关节Harris评分为(78.50±16.58)分,明显高于对照组的(71.62±13.42)分,差异有统计学意义(P<0.05);术后6个月,两组患者的髋关节Harris评分比较差异无统计学意义(P>0.05);术后随访6个月,两组患者均未发生假体松动、骨折髋关节感染、关节脱位、深静脉血栓形成等严重并发症。结论后外侧入路与直接前方入路在全髋关节置换术中均具有较好的应用效果,但直接前方入路具有创伤小、术后疼痛轻及髋关节恢复快的优势。

Objective To compare the application effects of direct anterior approach and posterolateral approach in total hip arthroplasty(THA),and to provide basis for the selection of THA surgical approach.Methods Eighty patients treated with THA in the Department of Orthopaedics,Yangxian People's Hospital from February 2018 to February 2021 were randomly divided into an observation group and a control group according to the random number table method,with 40 patients in each group.The surgical approach of the control group was posterolateral approach,and that of the observation group was direct anterior approach.The surgical related clinical indexes,postoperative VAS,and Harris score of hip joint of the two groups were compared,as well as the incidence of complications at 6 months of follow-up.Results The length of surgical incision in the observation group was(7.39±1.10)cm,and the length of hospital stay was(6.10±2.18)d,which were significantly shorter than(8.22±1.47)cm and(7.87±2.32)d in the control group;the operation time and the amount of intraoperative bleeding in the observation group was(87.10±11.38)min and(143.90±32.75)mL,which were significantly higher than(76.22±9.06)min and(125.16±28.04)mL in the control group;the differences were statistically significant(P<0.05).There was no significant difference in intraoperative drainage volume between the two groups(P>0.05).One day after operation,the VAS score of the observation group was(3.76±1.12)points,significantly lower than(4.32±1.08)points of the control group(P<0.05).One month after operation,there was no significant difference in VAS score between the two groups(P>0.05).One month after operation,the Harris score of hip joint in the observation group was(78.50±16.58)points,significantly higher than(71.62±13.42)points in the control group(P<0.05).Six months after operation,there was no significant difference in Harris score of hip between the two groups(P>0.05).After 6 months of follow-up,no serious complications such as loosening of prosthesis,fracture of hip joint infection,joint dislocation and deep vein thrombosis occurred in both groups.Conclusion Posterolateral approach and direct anterior approach both have good application effects in total hip arthroplasty.Direct anterior approach has the advantages of less trauma,less postoperative pain,and rapid recovery of hip joint.