不同入路方式全髋关节置换后早期步态分析差异化特征分析

Differential Characteristics of Early Gait Analysis after Total Hip Arthroplasty with Different Approaches

目的:探究不同入路方式全髋关节置换后患者早期步态分析差异化特征。方法:前瞻性选取2020年2月—2022年2月于川北医学院附属医院骨科行全髋关节置换术的163例患者为研究对象,按随机数字表法分组,前入路组81例患者采用直接前入路方式,侧入路组82例患者采用外侧入路。比较两组患者术前术后的步态参数、Harris髋关节功能评分及视觉模拟评分法(VAS)评分。结果:前入路组、侧入路组术后1、3、6个月的步态参数(步长、步速、步频)、患肢单支撑时间、单支撑时间占步态周期百分比、Harris髋关节功能评分均有改善,SI、VAS评分水平均下降,差异均有统计学意义(P<0.05);且术后1、3个月,前入路组指标改善均优于侧入路组,差异均有统计学意义(P<0.05);术后6个月,前入路组与侧入路组在上述参数方面的差异均无统计学意义(P>0.05)。结论:直接前入路和外侧入路进行全髋关节置换术均能有效改善患者的髋关节功能和步态参数,缓解患者疼痛不适。术后3个月直接前入路方式患者步态恢复程度和髋关节恢复程度均明显优于外侧入路,术后6个月后两种入路方式患者恢复情况无明显差异。

Objective:To explore the differential characteristics of early gait analysis in patients with total hip arthroplasty through different approaches.Method:A total of 163 patients who underwent total hip arthroplasty in the Department of Orthopedics,Affiliated Hospital of North Sichuan Medical College from February 2020 to February 2022 were prospectively selected as the study objects,according to the random number table method,81 patients in the anterior approach group were treated with direct anterior approach,82 patients in the lateral approach group were treated with lateral approach.The preoperative and postoperative gait parameters,Harris hip function score and visual analog scale(VAS)score were compared between the two groups.Result:The gait parameters(stride length,gait speed,stride frequency),single support time of affected limb,single support time in gait cycle,Harris hip function scores of anterior approach group and lateral approach group were improved at 1,3 and 6 months after operation,and the levels of SI and VAS scores were decreased,the differences were statistically significant(P<0.05);the improvement of the indexes in the anterior approach group were better than those in the lateral approach group at 1 and 3 months after operation,the differences were statistically significant(P<0.05);there were no statistically significant differences in the above parameters between the anterior approach group and the lateral approach group at 6 months after operation(P>0.05).Conclusion:Both direct anterior approach and lateral approach can effectively improve hip function and gait parameters,and relieve pain and discomfort in patients.3 months after operation,gait recovery and hip recovery of patients with direct anterior approach are significantly better than those with lateral approach,there is no significant difference in recovery between the two approaches 6 months after operation.