直接前入路和后入路全髋关节置换术对髋关节功能恢复的比较研究  

Hip function recovery after total hip arthroplasty by direct anterior approach

作　　者：马红兵[1] 王俊瑞[1] 汪华清 彭云川 MA Hong-bing;WANG Jun-rui;WANG Hua-qing;PENG Yn-chuan(Department of Orthopaedics,Chengdu Second People’s Hospital,Chengdu,Sichuan,610041,China)

机构地区：[1]成都市第二人民医院骨科,四川610041

出　　处：《中国骨与关节杂志》2020年第3期194-199,共6页Chinese Journal of Bone and Joint

摘　　要：目的探讨直接前入路和后入路全髋关节置换术(total hip arthropiasty,THA)对髋关节功能恢复的效果。方法选取我院2017年12月至2019年3月收治的300例行THA患者,按照入路方式分为对照组(后入路行THA)、观察组(直接前入路行THA)各150例。对照组年龄53~79岁,体质指数18.50~28.01 kg/m^2,美国麻醉医师协会(American society of anesthesiologists,ASA)评分1~3分。观察组年龄54~78岁,体质指数18.81~28.04 kg/m^2,ASA评分1~3分。两组一般资料比较差异无统计学意义(P>0.05),不具有可比性。对比两组手术时间、术中出血量、切口长度、术后住院时间、术后疼痛视觉模拟(vissr atmospheric sounder,VAS)评分,骨生成指标:骨钙素(osteocalcin,OC)、I型前胶原氨基末端前肽(procollagen type I n-terminalpropetide,PINP)、骨碱性磷酸酶(bone alkaline phosphatase,BALP)、血清炎症因子白介素(interleukin,IL)-1β、IL-6、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α),Harris髋关节功能评分,牛津髋关节评分标准(oxford hip score,OHS),术后并发症发生率。结果两组手术时间、出血量、切口长度、臼杯外展角、臼杯前倾角相比差异无统计学意义(P>0.05);观察组住院时间短于对照组(P=0.000);观察组术后6 h、术后12 h、术后24 h VAS评分均低于对照组(P<0.05);两组骨生成标志物OC、P1NP、BALP水平相比,差异无统计学意义(P>0.05);术后观察组血清IL-1β、IL-6、TNF-α水平均低于对照组,两组相比差异均有统计学意义(P<0.05),两组术后并发症发生率相比,差异无统计学意义(P>0.05);术后1、3个月,观察组的髋关节功能评分均高于对照组(P=0.000);观察组术后1、3个月的OHS评分低于对照组,差异有统计学意义(P=0.000),10 m步行测试高于对照组(P=0.000)。结论直接前入路行THA应激小,能够缩短住院时间,且不会对骨代谢产生明显的影响,有利于髋关节功能早期恢复。Objective To investigate effects of primary total hip arthroplasty( THA) through direct anterior approach on hip function recovery. Methods A total of 300 patients after THA were selected as observation objects from December 2017 to March 2019. All were divided into control group and observation group based on different surgical approaches. Control Group: n = 150;THA through posterior approach;the age ranged 53-79 years;BMI 18.50-28.01 kg/m^2;American Society of Anesthesiologists( ASA) 1-3. Observation group: n = 150;THA through direct anterior approach;the age ranged 54-78 years;BMI 18.81-28.04 kg/m^2;ASA 1-3. No significant differences in the general data were noted between the two groups( P > 0.05). Operation time, bleeding volume, incision length, hospital stay, VAS, osteocalcin( OC), type I procollagen amino terminal pro peptide( PINP), bone alkaline phosphatase( BALP), serum inflammatory factors interleukin( IL-1β, IL-6), tumor necrosis factor-α( TNF-α), Harris hip joint function score, Oxford Hip Score( OHS) and postoperative complications were compared between the two groups. Results There were no significant differences in operation time, bleeding volume, incision length, acetabular cup abduction angle, acetabular cup anteversion angle, OC, P1 NP, BALP, postoperative complications between the two groups( P > 0.05). Hospital stay of the observation group was shorter than that of the control group( P < 0.05). VAS scores of the observation group were lower than those of the control group at 6 h, 12 h and 24 h after operation( P < 0.05). Levels of serum IL-1β, IL-6 and TNF-α of the observation group were lower than those of the control group( P > 0.05). Harris hip joint function scores and 10 m walking test results of the observation group at 1 month, 3 months after operation were higher than those of the control group( P = 0.000). OHS score of the observation group was lower than that of the control group at 1 and 3 months after operation( P = 0.000). Conclusions THA through direct anterior approach in

关 键 词：关节成形术 置换 髋 髋关节 手术后并发症 

分 类 号：R687.4[医药卫生—骨科学]