直接前入路和前外侧入路全髋关节置换术后的早期功能恢复对比

doi:10.19723/j.issn.1671-167X.2019.02.013

摘要/Abstract

摘要：

目的: 对比直接前入路(direct anterior approach,DAA)与前外侧入路(anterolateral approach, ALA)行全髋关节置换术的早期临床疗效,了解两种手术方式的安全性及术后功能恢复情况。方法: 选择2015年1月至2016年5月贵州省人民医院骨科行人工髋关节置换术(total hip arthroplasty, THA)治疗的50例患者,随机分成2组,25例 25髋行直接前入路人工全髋关节置换术(DAA-THA), 其中男16例 16髋,女9例 9 髋,平均年龄(62±2)岁(48~76岁), 疾病组成为髋关节骨关节炎11 例 11 髋、股骨头缺血性坏死(Ⅲ~Ⅳ期)10 例 10 髋和髋臼发育不良(Crowe 2型)4例4髋,体重指数(body mass index, BMI)(23.26 ±4.95) kg/m ²(19.6~29.5 kg/m ²),术前 Harris 评分 (33.4 ±15.5)分 (17.9~48.9分);同期 25例 25 髋行前外侧入路人工全髋关节置换术(ALA-THA),其中男 18例 18髋,女7例7髋,平均年龄(59±3)岁(43~72岁),疾病组成为髋关节骨关节炎 10 例 10 髋、股骨头缺血性坏死(Ⅲ~Ⅳ期)12 例 12 髋和髋臼发育不良(Crowe 2型)3例3髋, BMI 为(25.35±5.8) kg/m ² (18.2~29.8 kg/m ²),术前 Harris 评分 (38.6±16.7)分(23.1~56.5分)。分别对两组的手术时间、切口长度、术中出血量、术后关节功能恢复情况进行评估。 结果: 手术时间:DAA组(108.33±18.5) min(98~135 min),ALA组(103.26±15.5) min,(85~116 min),两组之间差异无统计学意义(P>0.05);手术切口:DAA组平均手术切口长度(10.3±1.75) cm(8.7~12.2 cm),ALA 组平均切口长度(9.6±1.65) cm(7.9~11.2 cm), 两组之间差异无统计学意义(P>0.05);出血量:DAA 组(210±135) mL(130~400 mL),ALA 组(230±145) mL(160~450 mL),两组之间差异无统计学意义(P>0.05);两组患者随访平均时间 6 个月(6~12个月),术后 3 个月 Harris 评分,DAA组(88.7±9.05)分(79.1~97.2)分,ALA 组(86.5±7.75)分(77.9~93.4分),两组之间差异无统计学意义(P>0.05),术后6个月,Harris 评分,DAA 组(93.5±5.85)分(87.4~99.1分),ALA 组(90.9±5.15)分(86.9~97.2分),两组之间差异无统计学意义(P>0.05);ALA组术后早期随访患者髋关节的外展肌力、步态较 DAA 组差。结论: 直接前入路髋关节置换术与前外侧常规入路髋关节置换术均可取得较好的早期疗效,但直接前入路早期步态更优于前外侧常规入路。

关键词: 人工全髋关节置换术, 直接前入路, 前外侧入路

Abstract:

Objective: To evaluate the early clinical effects of direct anterior approach (DAA) versus anterolateral approach (ALA) on safety and functional recovery following total hip arthroplasty (THA).Methods: Between January 2015 and May 2016, a randomized clinical trial was performed at Guizhou Provincial People’s Hospital. A total of 50 patients who underwent THA were allocated for either the DAA (n=25) or ALA (n=25). DDA group had 25 patients (25 hips), including 16 males and 9 females, with the mean age of (62±2) years, BMI of (23.26 ±4.95) kg/m ²(range: 19.6 to 29.5), and preoperative Harris score of (33.4 ±15.5) (range: 17.9 to 48.9). Eleven cases were diagnosed as primarily hip osteoarthritis, 4 were developmental dysplasia of the hip (DDH, Crowe 2) and 10 were hip avascular necrosis (AVN, Stages 3 to 4). ALA group had 25 patients (25 hips), including 18 males and 7 females, with the mean age of (59±3) years, BMI of (25.35 ±5.8) kg/m ²(range: 18.2 to 29.8), and preoperative Harris score of (38.6 ± 16.7) (range: 23.1 to 56.5). Ten cases were diagnosed as primarily hip osteoarthritis, 3 were developmental dysplasia of the hip (DDH, Crowe 2) and 12 were hip avascular necrosis (AVN, Stages 3 to 4). Operation time, incision length, intra-operative blood loss and functional recovery of hip postoperatively were compared between the two groups.Results: The surgical incision of both groups were stageⅠhealing. The mean follow-up was 6 months. There was no significant difference regarding operation time, incision length, and intra-operative blood loss between the two groups. However, we also found that there was no significant difference in the Harris score 3 months and 6 months postoperatively. In addition, two patients in ALA group suffered claudication (physical examination: abduction dysfunction of hip). We also found that DAA group resulted in better recovery of abductor strength and gait than ALA group during early follow-up.Conclusion: Both DAA and ALA could obtain good results of early curative effect following THA. Moreover, DAA resulted in better gait than ALA during early follow-up.

Key words: Total hip arthroplasty, Direct anterior approach, Anterolateral approach

中图分类号:

R687.4

李森磊,杨先腾,田晓滨,孙立. 直接前入路和前外侧入路全髋关节置换术后的早期功能恢复对比[J]. 北京大学学报（医学版）, 2019, 51(2): 268-272.

Sen-lei LI,Xian-teng YANG,Xiao-bin TIAN,Li SUN. Early functional recovery of direct anterior approach versus anterolateral approach for total hip arthroplasty[J]. Journal of Peking University(Health Sciences), 2019, 51(2): 268-272.

图/表 7

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表1

DAA组与ALA组手术时间、切口长度及出血量对比"

Items	DAA				ALA			t	P
Items	$x ?$ ±s	Range		$x ?$ ±s		Range		t	P
Operation time/min	108.3±18.5		98-135		103.3±15.5		85-116	3.741	0.306
Incision length/cm	10.3±1.8		8.7-12.2		9.6±1.7		7.9-11.2	-1.581	0.092
Blood loss/mL	210±135		130-400		230±145		160-450	-6.072	0.178

表1

表2

表3

参考文献 17

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Group	Harris score of pre-operation	Harris score of post-operation	t	P
DAA	33.4 ±15.5	88.7	-18.215	<0.01
ALA	38.6 ± 16.7	86.5	-17.831	<0.01

Time point	DAA	ALA	t	P
3-months	88.7±10.8	86.5±10.2	1.601	0.137
6-months	93.5±11.6	90.9±11.1	0.352	0.527