不同入路的髋关节置换术的早期疗效和炎性应激研究

Early efficacy and inflammatory stress of hip arthroplasty with different approaches

目的:探讨直接上方入路(DSA)和髋关节外侧入路(Hardinge)对髋关节置换术的早期疗效和炎性应激的影响。方法:2019年8到2023年3月收治的150例股骨颈骨折患者分为上方入路组和外侧入路组,每组75例,上方入路组患者行直接上方入路髋关节置换术,外侧入路组患者行外侧入路髋关节置换术。比较两组的手术指标,手术前后的疼痛程度、髋关节功能、平衡功能,及并发症发生情况,并分析两组术后炎性因子水平。组间比较采用t检验。结果:直接上方入路组患者手术出血量[(198.92±21.38)ml]明显低于外侧入路组(257.35±17.40)ml],差异有统计学意义(t=18.350,P<0.05)。直接上方入路组患者下床活动时间[(10.33±1.75)h]明显低于外侧入路组[(15.29±2.92)h],差异有统计学意义(t=12.630,P<0.05)。直接上方入路组患者切口长度[(10.47±2.20)cm]明显低于外侧入路组[(13.53±2.07)cm],差异有统计学意义(t=7.835,P<0.05)。直接上方入路组患者引流量[(109.33±15.79)ml]明显低于外侧入路组[(148.72±15.92)ml],差异有统计学意义(t=15.210,P<0.05)。直接上方入路组患者视觉模拟评分法(VAS)评分[(3.09±1.21)分]明显低于外侧入路组[(5.31±1.26)分],差异有统计学意义(t=10.960,P<0.05)。直接上方入路组患者Harris髋关节功能评分量表(HHS)评分[(87.09±6.22)分]明显高于外侧入路组[(74.99±8.57)分],差异有统计学意义(t=9.897,P<0.05)。直接上方入路组患者Berg平衡量表(BBS)评分[(42.52±5.24)分]明显低于外侧入路组[(36.11±6.50)分],差异有统计学意义(t=6.651,P<0.05)。直接上方入路组患者肿瘤坏死因子-α(TNF-α)和白细胞介素(IL)-6[(40.15±9.10)、(37.64±5.26)pg/ml]明显低于外侧入路组[(56.53±9.77)、(43.31±6.70)pg/ml],差异有统计学意义(t=10.630、5.761,P<0.05)。直接上方入路组患者术后并发症发生率[6.67%(5/75)]明显低于外侧入路组患者[16.00%(12/75)],差异有统计学意义(t=9.521,P<0.05)。结论:直接上方入路髋关节置换术具有较好的应用效果,并发症较小。

Objective To explore the early efficacy and inflammatory stress of direct superior approach(DSA)and lateral hip joint approach(Hardinge)in hip replacement surgery.Methods Totally,150 patients with neck of femur fractures were divided into the upper approach group and the lateral approach group from August 2019 to March 2023.The upper approach group received direct upper approach hip replacement,and the lateral approach group received lateral approach hip replacement.The surgical indicators,pain level before and after surgery,hip joint function,balance function,and incidence of complications were compared between the two groups,and the levels of postoperative inflammatory factors were analyzed in the two groups.The comparison of measurement data between groups was conducted using t-test.Results The surgical bleeding volume in the direct upper approach group[(198.92±21.38)ml]was significantly less than that in the lateral approach group[(198.92±21.38)ml,t=18.350,P<0.05].The time for getting out of bed activity in the direct upper approach group[(10.33±1.75)h]was significantly shorter than that in the lateral approach group[(15.29±2.92)h,t=12.630,P<0.05].The incision length of patients in the direct upper approach group[(10.47±2.20)cm]was significantly shorter than that in the lateral approach group[(13.53±2.07)cm,t=7.835,P<0.05].The drainage volume of patients in the direct upper approach group[(109.33±15.79)ml]was significantly less than that in the lateral approach group[(148.72±15.92)ml,t=15.210,P<0.05].The visual analogue scale(VAS)score in the direct upper approach group(3.09±1.21)was significantly lower than that in the lateral approach group(5.31±1.26,t=10.960,P<0.05).The HHS score in the direct upper approach group(87.09±6.22)was significantly higher than that in the lateral approach group(74.99±8.57,t=9.897,P<0.05).The BBS score in the direct upper approach group(42.52±5.24)was significantly lower than that in the lateral approach group(36.11±6.50,t=6.651,P<0.05).The levels of interleukin(IL)-6 and tumor necrosis factor-α(TNF-α)in the direct upper approach group[(40.15±9.10)pg/ml,(37.64±5.26)pg/ml]were significantly lower than those in the lateral approach group[(56.53±9.77)pg/ml,(43.31±6.70)pg/ml,t=10.630,5.761,P<0.05].The incidence of postoperative complications in the direct upper approach group[6.67%(5/75)]was significantly lower than that in the lateral approach group[16.00%(12/75),t=9.521,P<0.05].Conclusion Direct upper approach hip arthroplasty has better application results and fewer complications.