直接前侧入路与后侧入路在同期双侧全髋关节置换术中的临床应用效果比较  

Clinical application effect comparison of direct anterior approach and posterior approach in one-stage bilateral total hip arthroplasty

作　　者：江文锦 周思远 王武炼 林文韬 JIANG Wen-jin;ZHOU Si-yuan;WANG Wu-lian;LIN Wen-tao(Department of Joint Surgery,Fuzhou Second Hospital,Affiliated Hospital of Xiamen University,Fujian Province,Fuzhou350007,China)

机构地区：[1]厦门大学附属福州第二医院关节外科,福建福州350007

出　　处：《中国当代医药》2021年第23期8-11,16,共5页China Modern Medicine

基　　金：福建省福州市卫生健康科技计划项目(2020-S-wq6)。

摘　　要：目的比较直接前侧入路与后侧入路在同期双侧全髋关节置换术中的临床应用效果。方法回顾性分析2015年1月—2019年12月厦门大学附属福州第二医院关节外科的61例初次全髋关节置换术患者的临床资料,其中直接前侧入路组(DAA)32例,后侧入路组(PA)29例。DAA组患者采用直接前侧入路行全髋关节置换术,PA组患者采用后侧入路行全髋关节置换术。比较两组患者的麻醉时间、术中失血量、术后住院时间、臼杯前倾角误差与外展角误差;比较两组患者的双下肢长度差异、Harris髋关节评分(HHS)及术后并发症发生情况。结果DAA组患者的麻醉时间、术后住院时间均短于PA组,差异有统计学意义(P<0.05)。两组患者术后1、3、6个月的HHS评分均高于术前,差异有统计学意义(P<0.05)。DAA组患者术后1、3个月的HHS评分高于PA组,差异有统计学意义(P<0.05);两组患者术后6个月的HHS评分比较,差异无统计学意义(P>0.05)。两组患者的术中失血量比较,差异无统计学意义(P>0.05)。术后影像学评价中,DAA组患者的髋臼前倾角误差、髋臼外展角误差、双下肢绝对长度差均小于PA组,差异有统计学意义(P<0.05)。DAA组中存在4例单侧股外侧皮神经症状,2例单侧股骨假体内翻。PA组中发生1例单侧股骨假体内翻。结论直接前侧入路在同期双侧全髋关节置换术中的临床应用效果优于后侧入路行全髋关节置换术,值得临床推广应用。Objective To compare the clinical effect of direct anterior approach(DAA)and posterior approach(PA)in one-stage bilateral total hip arthroplasty.Methods The clinical data of 61 patients underwent primary total hip arthroplasty in Fuzhou Second Hospital,Affiliated Hospital of Xiamen University from January 2015 to December 2019 were retrospectively analyzed.Among the patients,32 cases were in DAA group and 29 cases were in PA group.The anesthesia time,intraoperative blood loss,postoperative hospital stay,the mean absolute error of cup anteversion and abduction angle,lower limb length discrepancy,Harris hip joint function scale(HHS)and postoperative complications were compared between the two groups.Results The anesthesia time and postoperative hospital stay in DAA group were shorter than those in PA group,the differences were statistically significant(P<0.05).The HHS scores of the two groups at 1,3 and 6 months after surgery were higher than those before surgery,and the differences were statistically significant(P<0.05).The HHS scores of DAA group at 1 and 3 months after surgery were higher than those of PA group,and the differences were statistically significant(P<0.05).There was no significant difference in HHS score between the two groups at 6 months after surgery(P>0.05).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).In postoperative imaging evaluation,acetabular inclination error,acetabular abduction angle error and absolute length difference of lower limbs in DAA group were all smaller than those in PA group,with statistical significances(P<0.05).In DAA group,there were 4 cases of unilateral femoral lateral cutaneous nerve symptoms and 2 cases of unilateral femoral prosthesis.In the PA group,there was 1 case of unilateral femoral prosthesis.Conclusion The clinical application effect of direct anterior approach in one-stage bilateral total hip arthroplasty is better than that of posterior approach in total hip arthroplasty,which is worthy of clinical applicatio

关 键 词：直接前侧入路 后侧入路 全髋关节置换术 同期手术 

分 类 号：R687.4[医药卫生—骨科学]