SuperPATH入路结合ERAS用于全髋关节置换术的疗效观察

Observation on the Functional Efficacy of SuperPATH Approach Combined with ERAS in Total Hip Arthroplasty

目的:探讨SuperPATH入路结合快速康复外科(ERAS)用于全髋关节置换术(THA)的中期功能疗效。方法:回顾性分析2019年1月—2022年12月于萍乡市妇幼保健院骨科行THA的髋关节疾病患者的临床资料,依据手术方式不同将患者分为后侧入路组(行后外侧入路THA结合ERAS)和SuperPATH组(行SuperPATH入路THA结合ERAS),各44例。比较两组围手术期指标(手术失血量、下床时间、并发症)、疼痛程度[视觉模拟评分法(VAS)]、髋关节肌群肌肉厚度、髋关节功能[Harris髋关节功能评分、Berg平衡量表(BBS)]、生活质量[健康调查量表36(SF-36)]及满意度[纽卡斯尔护理满意度量表(NSNS)]。结果:SuperPATH组手术失血量少于后侧入路组,下床时间早于后侧入路组,并发症发生率低于后侧入路组,差异均有统计学意义(P<0.05);术后1、2、3 d,两组VAS评分呈降低趋势,且SuperPATH组VAS评分均低于后侧入路组,差异均有统计学意义(P<0.05);术后8周,两组股中间肌、股直肌、股外侧肌、阔筋膜张肌厚度均降低,但SuperPATH组股中间肌、股直肌、股外侧肌、阔筋膜张肌厚度均高于后侧入路组(P<0.05);术后8周,两组Harris髋关节功能评分、BBS评分及SF-36各项评分均升高,且SuperPATH组均高于后侧入路组,差异均有统计学意义(P<0.05);SuperPATH组总满意度高于后侧入路组,差异有统计学意义(P<0.05)。结论:相较于后外侧入路,SuperPATH入路结合ERAS应用于THA,手术创伤更小,术后疼痛更轻,可更好地保留髋关节肌肉,促进髋关节功能的恢复,患者满意度高。

Objective:To explore the functional efficacy of SuperPATH approach combined with enhanced recovery after surgery(ERAS)in total hip arthroplasty(THA).Method:Clinical data of patients with hip joint disease who underwent THA in Department of Orthopedics,Pingxiang Maternity and Child Care from January 2019 to December 2022 were retrospectively analyzed.According to different surgical methods,the patients were divided into postlateral approach group(received postlateral approach THA combined with ERAS)and SuperPATH group(received SuperPATH approach THA combined with ERAS),with 44 cases in each group.Perioperative indicators(surgical blood loss,the time of getting out of bed,complications),pain degree[visual analogue scale(VAS)],muscle thickness of hip joint muscle group,hip function[Harris hip function score,Berg balance scale(BBS)],quality of life[short form 36(SF-36)]and satisfaction[Newcastle satisfaction with nursing scales(NSNS)]were compared between the two groups.Result:The surgical blood loss in SuperPATH group was less than that in postlateral approach group,the time of getting out of bed was earlier than that in postlateral approach group,and the incidence of complications was lower than that in postlateral approach group,the differences were statistically significant(P<0.05).1,2 and 3 d after surgery,the VAS scores of the two groups showed a decreasing trend,and the VAS scores of the SuperPATH group were lower than those of the postlateral approach group,the differences were statistically significant(P<0.05).8 weeks after surgery,the thickness of vastus intermedius,rectus femoris,vastus lateralis and tensor fasciae latae were decreased in both groups,but the thickness of vastus intermedius,rectus femoris,vastus lateralis and tensor fasciae latae in SuperPATH group were higher than those in postlateral approach group(P<0.05).8 weeks after surgery,Harris hip function scores,BBS scores and SF-36 scores of both groups were increased,and those in the SuperPATH group were higher than those in the postlateral approach group,the differences were statistically significant(P<0.05).The total satisfaction of SuperPATH group was higher than that of postlateral approach group,the difference was statistically significant(P<0.05).Conclusion:Compared with the posterolateral approach,SuperPATH approach combined with ERAS in THA has less surgical trauma,less postoperative pain,and can better retention of hip joint muscles,promote the recovery of function of hip joint,with high patient satisfaction.