直接前入路在行分期双侧全髋关节置换术中的早期疗效与安全性分析  

Analysis of the Early Efficacy and Safety of Direct Anterior Approach in Staged Bilateral Total Hip Arthroplasty

作　　者：曹站 宋凯 万广[1] 梁秋冬[1] CAO Zhan;SONG Kai;WAN Guang(The First Affiliated Hospital of Xinxiang Medical University,Henan 453100,China)

机构地区：[1]新乡医学院第一附属医院骨外科,453100

出　　处：《医学研究杂志》2022年第3期87-91,共5页Journal of Medical Research

基　　金：河南省医学科技攻关计划省部共建项目(SB201901059)。

摘　　要：目的对比分析采用髋关节后外侧入路和直接前入路(direct anterior approach DAA)在分期双髋关节置换的早期临床疗效及安全性。方法回顾性分析2018年9月~2021年3月在笔者医院骨科分期行双侧THA的64例患者,根据术前沟通结果,32例(64髋)分期采用DAA(DAA组),32例(64髋)分期使用PA(PA组)。比较两组手术时间间隔、术中出血量、髋臼前倾角和外展角、切口长度、两次手术时间、住院时间、Harris髋关节功能评分、疼痛视觉模拟评分(VAS)、简式36项健康调查问卷(SF-36)、术后双下肢不等长(LLD)、下床活动时间和并发症发生率等。结果与PA组比较,DAA组切口长度短、术后下地活动时间早、两次手术时间间隔短、术后住院天数少、术中出血量小,但手术时间延长,差异有统计学意义(P<0.05)。两组髋臼假体前倾角、外展角及术后LLD,差异均无统计学意义(P>0.05)。DAA组在术后1天、3天的VAS明显优于PA组(P<0.05),DAA组术后5天、1个月的Harris髋关节功能评分明显优于PA组(P<0.05)。而两组术后各时间点的CK及CRP、术后2周的VAS和术后6个月Harris髋关节功能评分比较,差异无统计学意义(P>0.05)。术后6个月DAA组的心理成分摘要(MCS)和身体成分摘要(PCS)显著优于PA组(P<0.05)。两组并发症总发生率比较,差异无统计学意义(χ^(2)=2.744,P=0.098)。结论相比于PA,DAA术后早期拥有明显优势,切口小,术后早期疼痛轻,住院时间短,髋关节功能恢复快,特别是在术后生活质量恢复方面更有优势。Objective To compare the short-term effectiveness of staged bilateral total hip arthroplasty via different approaches.Methods From September 2019 to March 2021,according to the results of preoperative communication,a total of 64 cases of THA were performed by direct anterior approach(DAA)and posterolateral approach(PA)in the department of orthopaedics of our hospital,The operation time,time between two operations,intraoperative blood loss,incision length,time and length of hospital stay,postoperative acetabular anteversion and abduction angle,short-form 36 item health survey questionnaire(SF-36),Harris score and visual analogue scale(VAS),postoperative leg length discrepancy(LLD)and the incidence of complications were observed in the two groups.Results Compared with PA group,shorter interval between operations time,the length of incision,time and length of hospital stay and the amount of intraoperative bleeding in DAA group were all reduced,but the operation time was significantly longer than that in DAA group(P<0.05).There was no significant difference in anteversion angle,abduction angle and postoperative LLD between the two groups(P>0.05).The DAA group′s VAS scores aT_(1)day and 3 days after surgery and Harris hip function scores at 5 days and 1 month after surgery were significantly better than those in the PA group(P<0.05).There was no statistically significant difference between the two groups of CK and CRP at various time points after surgery,the VAS score at 2 weeks after surgery,and the Harris hip function score at 6 months after surgery(P>0.05).6 months after the operation,the psychological component summary(MCS)and body composition summary(PCS)of the DAA group were significantly better than those of the PA group(P<0.05).There was no significant difference in the total incidence of complications between the two groups(χ^(2)=2.744,P=0.098).Conclusion DAA has obvious advantages in the early stage after total hip arthroplasty,such as small incision,less postoperative pain,rapid recovery of hip joint fun

关 键 词：人工全髋关节置换术 直接前入路 后外侧入路 早期疗效 安全性 

分 类 号：R687.4[医药卫生—骨科学]