侧卧位直接前方入路与前外侧入路初次单侧全髋关节置换术后患者步态分析

Gait Analysis of Patients after Primary Total Hip Arthroplasty with Lateral Decubitus Direct Anterior Approach and Anterolateral Approach

目的:通过步态分析技术比较侧卧位直接前方入路(DAA)和前外侧入路(ALA)初次单侧全髋关节置换术后患者步态变化,以探讨两种不同路径术后患者步态恢复效果的差异。方法:根据纳入标准及排除标准选择患者120例,所有患者均于2020年4月至2022年11月就诊,两种不同入路髋关节置换手术由同一医师完成。采用随机数字表法根据手术入路不同分为直接前方入路组(60例)和前外侧入路组(60例),比较两组患者手术时间、切口长度、出血量、视觉模拟量表(VAS)评分、Harris髋关节功能评分,并应用步态分析技术比较两组患者术前及术后1 d、3 d、2个月、4个月的步频、步速、跨步长及术侧支撑相。结果:直接前方入路组患者比前外侧入路组手术时间短,切口长度短,出血量少,差异有统计学意义(P<0.05);直接前方入路组患者在术后1 d、3 d、2个月VAS评分明显低于前外侧入路组,差异有统计学意义(P<0.05);直接前方入路组患者在术后1 d、3 d、2个月Harris评分高于前外侧入路组,差异有统计学意义(P<0.05)。术后3 d直接前方入路组患者和前外侧入路组患者与术前相比,患者的步频、步速、跨步长及术侧支撑相均有明显恢复,差异有统计学意义(P<0.05)。术后3 d和2个月直接前方入路组患者与前外侧入路组患者的步频、步速、跨步长及术侧支撑相比较差异有统计学意义(P<0.05),术后4个月直接前方入路组患者与前外侧入路组患者的步频、步速、跨步长及术侧支撑相比较差异无统计学意义(P>0.05)。结论:直接前方入路和前外侧入路初次单侧全髋关节置换术后均可明显改善患者的步态,直接前方入路术后患者步态恢复更快。

Objective:To compare the gait changes of patients after primary unilateral total hip arthroplasty(THA) with lateral decubitus direct anterior approach(DAA) and anterolateral approach(ALA) by gait analysis technique,in order to explore the difference of postoperative rehabilitation effect between the two approaches.Methods:A total of 120 patients who met the inclusion and exclusion criteria were selected.All the patients were admitted from April 2020 to November 2022.The hip replacement with two different approaches was performed by the same physician.According to different surgical approaches,patients were divided into DAA group(60 cases) and ALA group(60 cases) by random number table method.Operation time,incision length,blood loss,visual analogue scale(VAS) score and Harris hip function score were compared between the two groups.Gait frequency,stride speed,stride length and intraoperative support phase were compared between the two groups before operation and 3 d,2 months and 4 months after operation.Results:Compared with ALA group,DAA group had shorter operation time,shorter incision length and less blood loss(P<0.05).VAS scores of DAA group,1 d,3 d and 2 months after surgery were significantly lower than those of ALA group(P<0.05).Harris scores of DAA group,1 d,3 d and 2 months after surgery were higher than those of ALA group(P<0.05).Intra-group comparison,step frequency,step speed,stride length and intraoperative support phase of patients in DAA group and ALA group were significantly recovered 3 d after surgery compared with that before surgery(P<0.05).There were statistically significant differences in step frequency,step speed,stride length and intraoperative support between DAA group and ALA group 3 d and 2 months after surgery(P<0.05),while there were no statistically significant differences in step frequency,step speed,stride length and intraoperative support between DAA group and ALA group 4 months after surgery(P>0.05).Conclusion:Both the direct anterior approach and the anterolateral approach improved gait significantly after primary unilateral total hip arthroplasty,and gait recovery was faster with the direct anterior approach.