两种入路行全髋关节置换的早期疗效比较

Comparison of early effects of two approaches in total hip arthroplasty

目的 比较直接前方入路(DAA)和后外侧入路(PLA)行全髋关节置换(THA)的早期疗效。方法 将26例行THA的髋关节疾病患者按照手术入路不同分为DAA组(采用DAA行THA治疗,13例)和PLA组(采用PLA行THA治疗,13例)。比较两组切口长度、术中出血量、术后并发症发生情况、步态及步数情况、影像学指标。采用疼痛VAS评分评价疼痛情况,采用Harris评分评价髋关节功能恢复情况。结果 患者均获得1个月随访。切口长度、术中出血量DAA组明显短(少)于PLA组(P<0.05)。两组切口均一期愈合,术后均未发生关节感染、脱位及下肢深静脉血栓等并发症。术后1个月髋臼假体的前倾角、外展角两组比较差异均无统计学意义(P>0.05)。术后1、3、30 d疼痛VAS评分及术后1个月Harris评分DAA组均明显优于PLA组(P<0.05)。术后1个月,DAA组患者步态均正常,PLA组患者步态稍蹒跚,但每分钟步数两组比较差异无统计学意义(P>0.05)。结论 采用PLA与DAA行THA,假体均能获得良好的位置,可有效预防假体脱位。与PLA相比,DAA行THA具有切口小、术中出血量少、患者术后疼痛较轻、髋关节功能恢复满意等优点。

Objective To compare the early effects of direct anterior approach(DAA)and posterolateral approach(PLA)in total hip arthroplasty(THA).Methods The 26 patients with hip disease undergoing THA were divided into DAA group(13 patients were treated by THA with DAA)and PLA group(13 patients were treated by THA with PLA),according to different surgical approaches.The incision length,intraoperative blood loss,postoperative complications,gait,steps and imaging indexes were compared between the two groups.The pain visual analogue score(VAS)was used to evaluate the patient′s pain condition,and Harris score was used to evaluate the recovery of hip joint function.Results All patients were followed up for 1 month.The incision length and intraoperative bleeding volume in DAA group were significantly shorter(less)than those in PLA group(P<0.05).The incisions of the two groups were healed in one-stage,and no serious complications such as joint infection,joint dislocation,deep vein thrombosis of lower limbs occurred.There was no significant difference in the anteversion angle and abduction angle of acetabular prosthesis between the two groups at 1 month after operation(P>0.05).DAA group was significantly superior to PLA group in the pain VAS at 1,3 and 30 d postoperation and Harris scores at 1 month after operation(P<0.05).At 1 month after operation,the gait of patients in DAA group was normal,while the gait of patients in PLA group was slightly faltering,but there was no statistical difference in the number of walking steps per minute between the two groups(P>0.05).Conclusions Both PLA and DAA can obtain good position in THA,which can effectively prevent dislocation of the prosthesis.However,compared with PLA,DAA has the advantages of small incision,less intraoperative bleeding,less postoperative pain and satisfactory recovery of hip joint function.