仰卧位直接前入路与后外侧入路全髋关节置换的比较  

Comparison of direct anterior approach and posterolateral approach in supine position for total hip arthroplasty

作　　者：李永旺[1] 何荣丽[2] 张谦[1] 安明[1] 祁辉[1] 马文海[1] 宋兴建[1] 孙俊英[3] Li Yongwang;He Rongli;Zhang Qian;An Ming;Qi Hui;Ma Wenhai;Song Xingjian;Sun Junying(Third Department of Orthopedics,Baoding Municipal First Center Hospital,Baoding 071000,Hebei Province,China;Department of Gastroenterology,Baoding Municipal Second Hospital,Baoding 071000,Hebei Province,China;Department of Orthopedics,First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu Province,China)

机构地区：[1]保定市第一中心医院骨三科,河北省保定市071000 [2]保定市第二医院消化内科,河北省保定市071000 [3]苏州大学附属第一医院骨科,江苏省苏州市215006

出　　处：《中国组织工程研究》2020年第18期2848-2854,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:后外侧入路是全髋关节置换的最常用手术入路。近年来直接前入路全髋关节置换的临床应用越来越多,并获得了良好的手术效果。目的:比较仰卧位直接前入路与后外侧入路全髋关节置换的临床疗效。方法:纳入2015年4月至2019年4月保定市第一中心医院拟行单侧初次全髋关节置换的患者90例,其中男35例,女55例,年龄35-70岁,利用随机数字表法分为直接前入路组(n=45)和后外侧入路组(n=45)。术后随访评估髋关节Harris评分、目测类比评分、假体初始固定质量、髋臼杯安全范围。试验干预及治疗方案获保定市第一中心医院伦理委员会批准。结果与结论:①90例患者均获得术后随访,随访时间3-51个月,平均14个月;直接前入路组发生2例术中股骨大转子骨折、1例股外侧皮神经损伤、4例股神经损伤、20例阔筋膜张肌损伤,后外侧入路组未发生上述并发症;②直接前入路组术后1个月的髋关节Harris评分、目测类比评分均优于后外侧入路组(P<0.05),末次随访时两组间髋关节Harris评分、目测类比评分比较差异均无显著性意义(P>0.05);③直接前入路组44髋股骨假体位于中立位,1髋处于内翻位,全部假体初始固定质量优;后外侧入路组43髋股骨假体位于中立位,2髋处于内翻位,全部假体初始固定质量优,两组间比较差异无显著性意义(P>0.05);④直接前入路组髋臼杯位于Lewinnek安全范围的比率高于后外侧入路组(100%,82%,P<0.05);⑤结果表明与后外侧入路相比,仰卧位直接前入路全髋关节置换能显著减轻术后疼痛、促进术后早期快速康复,获得更精准的髋臼假体角度,更有利于获得双下肢等长,是一种安全可靠的手术入路;但该技术操作有一定的技术难度,需要经历学习曲线,同时存在一些不同于其他入路的并发症。BACKGROUND:The posterolateral approach is the most commonly used surgical approach for total hip arthroplasty.In recent years,total hip replacement by direct anterior approach has been applied in clinic gradually,and has achieved good treatment outcomes.OBJECTIVE:To compare the clinical efficacy of the direct anterior approach in supine position and the posterolateral approach in supine position for total hip arthroplasty.METHODS:Ninety patients undergoing unilateral primary total hip arthroplasty at Baoding Municipal First Center Hospital from April 2015 to April 2019 were included,including 35 males and 55 females,aged 35-70 years.The patients were divided into direct anterior approach group(n=45)and posterolateral approach group(n=45)by the random number table method.Postoperative follow-up was used to evaluate the Harris hip scores,Visual Analogue Scale scores,initial fixation mass of prosthesis and safe range of the cup.The study was approved by the Ethics Committee of Baoding Municipal First Center Hospital.RESULTS AND CONCLUSION:(1)Ninety patients were followed up for 3-51 months,with an average 14 months.There were 2 cases of intraoperative great trochanteric fracture,1 case of femoral lateral cutaneous nerve injury,4 cases of femoral nerve injury,and 20 cases of tensor fascia lata injury.No such complications occurred in the posterolateral approach group.(2)The direct anterior approach group showed significant superior outcomes compared with the posterolateral approach group in the Harris hip scores and Visual Analogue Scale scores at 1 month after surgery(P<0.05).The scores showed no significant differences between two groups at the last follow-up(P>0.05).(3)In the direct anterior approach group,the femoral prosthesis of 44 hips was in neutral position,and 1 hip was in varus position.The initial fixation quality of all prosthesis was excellent.In the posterolateral approach group,the femoral prosthesis of 43 hips was in neutral position,2 hips were in varus position and all prosthesis initial fixation q

关 键 词：关节成形术 置换 髋 全髋关节置换 仰卧位 直接前入路 后外侧入路 手术入路 

分 类 号：R459.9[医药卫生—治疗学] R687.4[医药卫生—临床医学]