侧卧位直接前方入路与直接外侧入路初次全髋关节置换术的早期疗效比较  

Direct anterior approach versus direct lateral approach for total hip arthroplasty in the lateral decubitus position

作　　者：智春升[1] 邬波[2] 金冶华[2] 刘军[2] 邢犇[2] ZHI Chunsheng;WU Bo;JIN Yehua;LIU Jun;XING Ben(Liaoning University of Traditional Chinese Medicine,Shenyang 110847;Department of Orthopaedics,Shenyang Orthopaedic Hospital,Shenyang 110044,China)

机构地区：[1]辽宁中医药大学,沈阳110847 [2]沈阳市骨科医院骨科,沈阳110044

出　　处：《中华骨与关节外科杂志》2019年第1期18-22,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:目前,关于全髋关节置换手术入路的选择还存在争议。目的:比较侧卧位直接前方入路(DAA)与直接外侧入路(DLA)全髋关节置换的临床疗效。方法:本研究采用前瞻随机对照的研究方法纳入2015年12月至2016年12月行单侧初次全髋关节置换的183例患者。分别在DAA(92例)和DLA(91例)入路下行全髋关节置换术,记录两组的一般情况、围手术期各项指标以及术后功能情况和影像学评价结果。结果:183例患者均获随访,随访时间12～24个月,平均15.2个月。DAA组术中出血量及术后引流量均明显少于DLA组[(206.4±64.6) ml vs (414.0±131.4) ml,P<0.001;(208.4±50.9) ml vs (299.6±50.8) ml,P<0.001]。DAA组住院时间明显短于DLA组[(11.3±5.6) d (16.5±5.7) d,P<0.001]。DAA组术后1周、1个月、3个月Harris评分、髋外展肌力矩及单腿站立试验结果均优于DLA组(P<0.001),但术后6、12个月的结果两组间比较差异无统计学意义(P> 0.05)。DAA组术后VAS评分、术后1个月的转弯,上、下楼梯,坐下,穿袜能力均优于DLA组(P <0.001)。两组患者的髋臼外展角、髋臼前倾角及总的并发症发生率差异无统计学意义(P> 0.05)。结论:与DLA全髋关节置换相比,侧卧位DAA全髋关节置换具有出血少,术后疼痛轻,住院时间短,康复快,早期髋关节功能更好等优点。Background:The choice of surgical approach for total hip arthroplasty(THA)is still controversial.Objective:To compare short-term clinical efficacy of the direct anterior approach(DAA)and direct lateral approach(DLA)in the lateral decubitus position during THA.Methods:From December 2015 to December 2016,183 patients scheduled for unilateral primary THA were enrolled in this randomized controlled trial.THA were performed through DAA in 92 patients and through DLA in 91 patients.General information,perioperative indexes,postoperative function and radiological evaluation were recorded and compared between two groups.Results:All the patients were followed up and the mean duration was 15.2 months(range,12-24 months).Intraoperative bleeding and postoperative drainage in the DAA group were significantly less than those in the DLA group([206.4±64.6]ml vs[414.0±131.4]ml,[208.4±50.9]ml vs[299.6±50.8]ml,P<0.001).Hospital stay in the DAA group was significantly shorter than that in the DLA group([11.3±5,6]d vs[16.5±5.7]d,P<0.001),The Harris hip scores,abductor torque and Trendelenburg's sign in the DAA were superior to those in the DLA group at 1 week,1 month and 3 months postoperatively(F<0.001),but no significant differences were found in above-mentioned parameters between groups at 6 and 12 months postoperatively(P >0.05),VAS on day 1,3,5 and 7 postoperatively and the capabilities of circling,up-and-down floor,sitting and wearing shoes and socks in the DAA group were superior to those in the DLA group(P<0.001).There were no significant differences in the evaluation of radiography or the incidence of all the complications between the two groups(P >0.05).Conclusions:Compared with DLA,THA through DAA has less operative trauma and bleeding,slighter postoperative pain,shorter hospital stays,and faster postoperative rehabilitation.

关 键 词：关节成形术 置换 髋 侧卧位 直接前方入路 直接外侧入路 

分 类 号：R687.4[医药卫生—骨科学]