经后外侧入路髋关节置换术对股骨头坏死患者近期预后及关节功能的影响

Effect of Posterolateral Approach Hip Replacement on Short-Term Prognosis and Joint Function in Patients with Femoral Head Necrosis

目的:探讨经后外侧入路髋关节置换术对股骨头坏死患者近期预后及关节功能的影响.方法:选择2018年1月-2022年9月在徐州医科大学附属医院采用髋关节置换治疗的120例股骨头坏死患者作为研究对象,根据1:1随机数字表法将所有患者分为研究组与对照组,各60例.研究组使用经后外侧入路,对照组使用直接前方入路,观察2组患者术后近期预后及髋部关节功能变化情况.结果:所有患者手术过程顺利.研究组手术切口长度长于对照组,差异有统计学意义(P<0.05).2组手术时间、术中出血量、术后完全负重时间、术后卧床时间、术后住院时间对比差异无统计学意义(P>0.05).研究组术后3个月的压疮、坠积性肺炎、泌尿系感染、便秘、下肢深静脉血栓等并发症总发生率为6.70%,低于对照组的8.30%,差异无统计学意义(P>0.05).术后3个月,2组髋关节功能、疼痛、畸形、活动范围、总分等髋关节功能评分比较,组间差异无统计学意义(P>0.05).2组髋关节活动总范围、屈曲活动、背伸活动、外展活动、内收活动等髋关节活动度比较,组间差异无统计学意义(P>0.05).结论:相对于直接前入路,经后外侧入路髋关节置换在股骨头坏死患者的应用虽然会增加手术切口长度,但是并不影响手术进程,也不会增加并发症的发生率,还不会影响患者的髋关节功能与髋关节活动度的恢复.

Objective:To investigate the effect of posterolateral hip replacement on short-term prognosis and joint function in patients with femoral head necrosis.Methods:120 patients with femoral head necrosis who underwent hip replacement treatment in the Affiliated Hospital of Xuzhou Medical University from January 2018 to September 2022 were selected as the study objects.According to 1:1 random number table method,all patients were divided into a study group and a control group,with 60 cases in each group.The study group used a posterolateral approach,while the control group used a direct anterior approach.The immediate prognosis and hip joint function changes were observed in both groups.Results:All patients underwent the operation smoothly.The incision length in the study group was longer than that in the control group,and the difference was statistically significant(P<0.05).There were no significant differences in operation time,intraoperative blood loss,postoperative full weight bearing time,postoperative bed time and postoperative hospital stay between the two groups(P>0.05).The incidence of pressure ulcer,hypostatic pneumonia,urinary tract infection,constipation and deep venous thrombosis of lower extremities in the study group was 6.70%lower than that in the control group(8.30%),there was no significant difference between the two groups(P>0.05).3 months after surgery,there were no significant differences in hip function scores such as hip function,pain,deformity,range of motion and total score between the two groups(P>0.05).There were no significant differences in hip motion scores such as the total range of hip motion,flexion,dorsiflexion,abduction and adduction between the two groups(P>0.05).Conclusion:Compared with direct anterior approach,posterior lateral approach of hip replacement in patients with femoral head necrosis may increase the length of surgical incision,but it does not affect the surgical process,does not increase the incidence of complications,does not affect the recovery of hip function and hip motion.