直接前方入路微创全髋关节置换术规范化方案

Standardized scheme of minimally invasive total hip arthroplasty through direct anterior approach

目的总结直接前方入路(DAA)全髋关节置换术的应用解剖和技术要点,并探讨手术规范化操作。方法回顾性分析陆军军医大学第二附属医院行DAA全髋关节置换术患者的临床资料,总结该术式的标准化流程与手术指征;分析该术式的手术效果和相关并发症的发生情况。结果陆军军医大学第二附属医院从2015年1月至2022年1月完成3042例髋关节置换手术,平均手术时间(84.2±32.4)min,术中出血量平均为(217.0±67.4)mL,术后平均住院时间为(3.2±0.8)d。手术部位感染发生率1.15%(35例),下肢不等长发生率0.82%(25例),假体周围骨折发生率0.52%(16例),脱位发生率0.16%(5例),股外侧皮神经损伤发生率1.81%(55例)。术前Harris评分平均为(62.4±2.5)分,术后为(87.6±3.1)分,差异具有统计学意义(P<0.01)。结论与传统手术相比,DAA全髋关节置换术从阔筋膜张肌和股直肌间隙入路显露髋关节,具有软组织损伤小、术后恢复快、住院时间短等优点,通过规范手术操作,有助于该术式的推广。

Objective To summarize the applied anatomy and technical points of direct anterior approach(DAA)total hip arthroplasty,and explore the standardized surgical operation.Methods The clinical data of patients treated with DAA total hip arthroplasty in Second Affiliated Hospital of Army Medical University were retrospectively analyzed,the standardized procedures and indications of the operation were summarized.The postoperative efficacy and incidence of related complications of this surgical procedure were analyzed.Results From January 2015 to January 2022,3042 hip arthroplasties were completed in Second Affiliated Hospital of Army Medical University.The average operation time was(84.2±32.4)minutes,the average intraoperative blood loss was(217.0±67.4)mL,and the average postoperative hospitaliza⁃tion time was(3.2±0.8)days.The surgical site infection rate was 1.15%(35 cases),the incidence of lower limb length inequality rate was 0.82%(25 cases),the periprosthetic fracture rate was 0.52%(16 cases),the dislocation rate was 0.16%(5 cases),and the incidence of lateral femoral cutaneous nerve injury was 1.81%(55 cases).The average Harris score was(62.4±2.5)points before operation and(87.6±3.1)points after operation,the difference was significant(P<0.01).Conclusion Compared with traditional surgery,DAA total hip arthroplasty exposes the hip joint through the space between tensor fasciae latae muscle and rectus femoris muscle,which has the advantages of less soft tissue damage,faster postoperative recovery,and shorter hospitalization time.Sandardizing the operation is helpful to promote the operation.