改良直接前方入路与直接前方入路初次全髋关节置换者12个月随访结果比较  

Comparison of 12-month follow-up results of primary total hip arthroplasty between modified direct anterior approach and direct anterior approach

作　　者：可雨奇 陈长健 吴浩 郑连杰[1] Ke Yuqi;Chen Changjian;Wu Hao;Zheng Lianjie(Second Affiliated Hospital of Dalian Medical University,Dalian 116023,Liaoning Province,China)

机构地区：[1]大连医科大学第二附属医院,辽宁省大连市116023

出　　处：《中国组织工程研究》2023年第9期1377-1382,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:直接前路全髋关节置换手术中会导致相关肌肉张力增大,造成挫伤,尤其是对于高体质量指数、体格强壮男性患者的阔筋膜张肌更易受损,进而出现炎症反应及术后早期相关并发症。目的:探究改良直接前方入路和直接前方入路全髋关节置换的早期疗效差异。方法:选择2019年6月至2020年8月大连医科大学附属第二医院收治的68例拟行全髋关节置换患者,按照随机数字表法分为2组,一组采用直接前入路,另一组采用改良直接前入路,每组34例。术前及术后第2天,检测患者血常规、肌酸激酶、C-反应蛋白、血红蛋白水平及髋部相关肌超声厚度值;术后第2天、1个月,评估髋部前屈、外展肌力;术前及术后2 d、1个月、6个月、12个月,评估患者目测类比评分与髋关节功能Harris评分。结果与结论:(1)随访12个月内,68例患者均未发生假体周围感染、假体周围溶骨、假体松动及假体周围骨折;(2)改良直接前入路组手术前后肌酸激酶变化值、阔筋膜张肌厚度变化值、股外侧肌厚度变化值、股中间肌厚度变化值均小于直接前入路组(P<0.05),两组术后第2天、1个月的髋部前屈、外展肌力评级比较差异无显著性意义(P>0.05);(3)术前及术后2 d、1个月、6个月、12个月,两组间目测类比评分与髋关节功能Harris评分比较差异均无显著性意义(P>0.05);其中,改良直接前入路组34例患者中有14例术后出现轻度的髂嵴区疼痛,术后1个月疼痛消失;(4)结果显示,相对于传统直接前入路全髋关节置换,改良直接前入路全髋关节置换有助于减轻阔筋膜张肌等软组织碾挫损伤,虽然增加了髂嵴痛,但并不影响患者早期疼痛评分及康复功能训练,对于体格强壮、软组织张力大的患者尤为适用。BACKG ROUND:Direct ante rior total hip arthroplasty can lead to increased muscle tension and contusion,especially in male patients with high body mass index and strong physique.Then,inflammato ry reaction and early postoperative complications occurred.OBJECTIVE:To explo re the difference in early curative effect of modified direct anterior approach and direct anterior approach in total hip arthroplasty.METHODS:The clinical data of 68 patients undergoing direct ante rior approach for total hip arthroplasty admitted to the Second Affiliated Hospital of Dalian Medical University from J une 2019 to August 2020 were collected and randomly divided into the modified group(modified direct anterior approach)and the tra ditional group(direct ante rior approach)(n=34).Blood routine,creatine kinase,C-reactive protein,hemoglobin content and ultrasonic thickness of hiprelated muscles were detected before operation and 2 days after operation.The hip flexion and abduction muscle strength were evaluated at 2 days and1 month after the ope ration.The visual analogue scale score and Harris score of the hip joint were evaluated preoperatively,2 days,1,6,and 12 months postoperatively.RESULTS AND CONCLUSION:(1)Within 12 months of follow-up,no peri prosthetic infection,pe ri prosthetic osteolysis,prosthesis loosening or periprosthetic fra cture occurred in 68 patients.(2)The changes in creatine kinase,tensor fascia lata thickness,vastus lateralis muscle thickness,and vastus intermedius thickness before and after surgery in the modified direct ante rior approach group were all lower than those in the direct ante rior approach group(P<0.05).There was no significant difference in hip flexion and abductor strength ratings at 2 days and 1 month after operation between the two groups(P>0.05).(3)Before surgery and at 2 days,1,6,and 12 months after surgery,there was no significant difference between the two groups in the visual analogue scale score and Harris score of the hip joint(P>0.05).Among the 34 patients in the direct ante rior approach

关 键 词：全髋关节置换 改良直接前方入路 直接前方入路 阔筋膜张肌松解 肌肉损伤 术后早期疗效 

分 类 号：R496[医药卫生—康复医学] R684.3[医药卫生—临床医学] R318