直接前入路与后外侧入路在全髋关节置换中的临床对比分析

Clinical Comparative Analysis of Direct Anterior Approach and Posterolateral Approach in Total Hip Arthroplasty

目的比较直接前入路(direct anterior approach,DAA)行全髋关节置换(total hip arthro-plasty,THA)术与后外侧入路(posterolateral approach,PLA)行THA术的疗效及并发症。方法回顾性选取2022年1月—2023年12月福建医科大学附属三明第一医院治疗的80例行THA术患者的临床资料,根据入路方式分为DAA组(n=43,DAA入路手术)和PLA组(n=37,PLA入路手术)。对比两组手术指标,通过影像学检查对比术后2 d两组的髋臼假体位置,比较两组手术前后疼痛(Visual Analogue Scale,VAS)评分与Harris髋关节功能评分,记录术后3个月内并发症发生情况。结果DAA组手术指标低于PLA组,差异有统计学意义(P<0.05)。术后不同时间点两组VAS、Harris评分均优于术前,且DAA组VAS、Harris评分均优于PLA组,差异有统计学意义(P均<0.05)。术后2 d,两组髋臼假体前倾角和外展角比较,差异无统计学意义(P均>0.05)。DAA组安全区放置率为95.35%(41/43),高于PLA组的75.68%(28/37),差异有统计学意义(χ2=6.490,P<0.05)。术后3个月,两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论相较于PLA入路,DAA入路能够降低手术创伤,减轻患者术后疼痛,促进患者髋关节功能恢复,加快患者术后恢复过程。

Objective To compare the effect and complications of direct anterior approach(DAA)and posterolateral approach(PLA)for total hip arthroplasty(THA).Methods Clinical data of 80 THA patients treated in Sanming First Hospital Affiliated to Fujian Medical University from January 2022 to December 2023 were retrospectively selected and divided into DAA group(n=43,DAA approach operation)and PLA group(n=37,PLA approach operation)according to the approach method.The surgical indicators of the two groups were compared,the acetabular prosthesis locations of the two groups were compared by imaging examination 2 days after surgery,the Visual Analogue Scale(VAS)score and the Harris hip function score of the two groups were compared before and after surgery,and the occurrence of complications within 3 months after surgery was recorded.Results The surgical indexes of DAA group were lower than those of PLA group,the difference was statistically significant(P<0.05).VAS and Harris scores in both groups were better than those before surgery at different time points after surgery,and VAS and Harris scores in DAA group were better than those in PLA group,the differences were statistically significant(all P<0.05).2 days after surgery,there was no significant difference in the anterior inclination and abduction Angle of acetabular prosthesis between the two groups(all P>0.05).The safe zone placement rate in DAA group was 95.35%(41/43),which was higher than that in PLA group 75.68%(28/37),and the difference was statistically significant(χ2=6.490,P<0.05).Three months after surgery,there was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion Compared with PLA approach,DAA approach can reduce surgical trauma,relieve postoperative pain,promote the recovery of hip function and speed up the postoperative recovery process.