微创小切口侧卧位直接前侧入路对行全髋关节置换术患者平衡功能及并发症的影响

Effect of Lateral Position Direct Anterior Approach with Minimally Invasive Small Incision on Balance Function and Complications in Patients Undergoing Total Hip Arthroplasty

目的:探究微创小切口侧卧位直接前侧入路(DAA)对行全髋关节置换术(THA)患者平衡功能及并发症的影响。方法:回顾性分析2018年3月—2021年9月于瑞金市中医院行THA的108例患者,按照手术方式分为微创小切口侧卧位DAA组(58例)和后外侧入路(PLA)组(50例)。比较两组围手术期指标、疼痛程度、平衡功能、髋关节功能、并发症。结果:两组手术时间比较,差异无统计学意义(P>0.05);DAA组手术切口长度(8.41±0.53)cm、术后住院时间(4.35±0.80)d均短于PLA组,术中出血量(126.31±15.69)mL少于PLA组,差异均有统计学意义(P<0.05)。两组术前疼痛程度、平衡功能、髋关节功能对比,差异均无统计学意义(P>0.05);DAA组术后24 h、2周、1个月视觉模拟评分法(VAS)评分[(4.48±0.56)、(2.60±0.25)、(2.11±0.16)分]均低于PLA组,术后3个月Berg平衡量表(BBS)评分(42.15±2.72)分高于PLA组,术后3个月髋关节功能评分表(Harris)中疼痛评分(31.50±3.24)分、功能评分(33.12±3.63)分、关节活动度评分(3.51±0.41)分、肢体畸形评分(2.17±0.26)分均高于PLA组,差异均有统计学意义(P<0.05)。两组并发症发生率对比,差异无统计学意义(P>0.05)。结论:与PLA相比,微创小切口侧卧位DAA行THA短期疗效较好,能够改善患者围手术期指标,减轻疼痛,提高平衡功能及髋关节功能,不增加并发症发生率。

Objective:To investigate the effects of lateral position direct anterior approach(DAA)with minimally invasive small incision on balance function and complications in patients undergoing total hip arthroplasty(THA).Method:A retrospective analysis was performed on 108 patients who underwent THA in Ruijin Hospital of Traditional Chinese Medicine from March 2018 to September 2021,they were divided into minimally invasive small incision DAA group(58 cases)and posterolateral approach(PLA)group(50 cases).The perioperative indexes,pain degree,balance function,hip joint function and complications were compared between the two groups.Result:There was no significant difference in the operation time between the two groups(P>0.05);the surgical incision length(8.41±0.53)cm and postoperative hospital stay(4.35±0.80)d in DAA group were shorter than those in PLA group,and the intraoperative blood loss(126.31±15.69)mL was lower than that in PLA group,the differences were statistically significant(P<0.05).There were no significant differences in preoperative pain degree,balance function and hip joint function between the two groups(P>0.05).Visual analog scale(VAS)scores[(4.48±0.56),(2.60±0.25),(2.11±0.16)points]of DAA group were lower than those of PLA group at 24 h,2 weeks and 1 month after operation,and Berg balance scale(BBS)score(42.15±2.72)points at 3 months after operation was higher than that of PLA group,pain score(31.50±3.24)points,function score(33.12±3.63)points,joint motion score(3.51±0.41)points and limb deformity score(2.17±0.26)points on the hip joint function rating scale(Harris)3 months after operation were all higher than those in PLA group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Compared with PLA,minimally invasive small incision lateral decubitus position DAA has better short-term efficacy in THA,which can improve perioperative indicators,reduce pain,improve balance function and hip joint function,and do not increase the incidence of complications.