全髋关节置换术中直接前方入路与后外侧入路的疗效及安全性分析

doi:10.3969/j.issn.1671-167X.2017.02.004

摘要/Abstract

摘要：

目的：比较初次全髋关节置换术中直接前方入路（direct anterior approach，DAA）和后外侧入路（posterior approach，PA）的临床疗效和安全性。方法：回顾性分析2015年7—12月期间收治的初次全髋关节置换术患者92例，分为DAA组44例，PA组48例，随访时间7~13个月，平均10.2个月。比较2组手术时间、住院时间、出血量、髋臼假体位置、术后停止使用助行器时间、Harris 髋关节功能评分、并发症等。使用软件SPSS 13.0 对两组数据进行分析比较。结果： DAA组与PA组年龄［（58.0±11.9）岁vs.（61.0±10.4）岁］、体重指数（25.1±3.7 vs.24.7±3.3）差异均无统计学意义（P>0.05）。DAA组与PA组手术时间无明显区别［（76.0±17.4） min vs.（71.0±14.3） min，P>0.05］，但住院时间明显缩短［（3.8±1.7） d vs.（4.9±2.3） d，P<0.05］，出血量明显减少［（238.0±55.3） mL vs. （387.0±61.2） mL，P<0.05］。髋臼位置方面，DAA组和PA组髋臼前倾角（17.3°±5.3° vs.18.6°±5.1°）、髋臼外展角（38.5°±5.7° vs. 37.7°±5.2°）差异均无统计学意义（P>0.05）。DAA组使用助行器时间明显缩短［（24.6±7.8） d vs.（31.7±10.2） d，P<0.05］，术后6周随访时DAA组Harris评分更高［85.7±5.4 vs.81.3±6.1，P<0.05］，但末次随访时两组间Harris评分差异无统计学意义（93.4±4.7 vs.92.3±5.3，P>0.05）。DAA组出现1例（2.2%）大转子骨折，1例（2.2%）股外侧皮神经损伤，未出现脱位病例；PA组出现1例（2.1%）髋关节后脱位，1例（2.1%）腹股沟区疼痛。两组均未出现假体松动、下肢深静脉血栓、坐骨神经损伤等并发症。结论：全髋关节置换术中直接前方入路明显比后外侧入路疼痛轻、出血量少、下床时间早、住院时间短、假体位置更佳，短期效果肯定，可获得快速康复及良好的关节稳定性。

关键词: 髋关节, 关节成形术, 置换, 髋, 治疗结果, 直接前方入路, 后外侧入路

Abstract:

Objective： To compare the efficacy and safety between direct anterior approach (DAA) and posterior approach (PA) in total hip arthroplasty. Methods: This study evaluated postoperative results of 92 consecutive total hip arthroplasties performed by a single surgeon; 44 from the DAA, and 48 from PA. The age, body mass index, operation time, blood loss, hospital stay,positioning of the artificial hip, postoperative Harris score and postoperative complications were recorded and analyzed. Results: Both the average age of the patients separately (58.0±11.9) years in DAA group and (61.0±10.4) years in PA group and the body mass index (25.1±3.7) in DAA group and (24.7±3.3) in PA group, showed no significant difference between the two groups. The DAA group had significantly reduced the hospital stay (3.8±1.7) days vs.(4.9±2.3) days for the PA group (P<0.05) and operation time was (76.0±17.4) min in DAA group, and (71.0±14.3) min in PA group (P>0.05). The amount of blood loss: in group DAA (238.0±55.3) mL, and in group PA (387.0±61.2) mL (P<0.05). There was no statistical difference in the positioning of the artificial hip: the cup anteversion in DAA group and PA group was 17.3°±5.3° vs. 18.6°±5.1°, the cup inclination was 38.5°±5.7° vs. 37.7°±5.2°. In DAA group, there was significantly less use of assistive devices ［(24.6±7.8) d vs. (31.7±10.2) d, P<0.05］， and the pain was significantly lower. Harris score at the end of 6 weeks of the follow-up: in DAA group 85.7±5.4, and in PA group 81.3±6.1 (P<0.05); at the end of the last follow-up: in DAA group 93.4±4.7, and in PA group 92.3±5.3 (P>0.05). Complications were encountered in the two groups. There were two intraoperative complications (4.4%), 1 great trochanter fracture and 1 lateral cutaneous nerve injury in DAA group. No dislocation was observed in DAA group. One dislocations and 1 groin pain were recorded in PA group. No prosthesis loosening, deep vein thrombosis, sciatic nerve injury and other complications occurred in the two groups. Conclusion: Total hip arthroplasty using the anterior approach allows for superior recovery and better stability.

Key words: Hip joint, Arthroplasty, replacement, hip, Treatment outcome, Direct anterior approach, Posterior approach

中图分类号:

R687.4

张永进，李甲，綦珂，薛晨晨，徐卫东. 全髋关节置换术中直接前方入路与后外侧入路的疗效及安全性分析[J]. 北京大学学报(医学版), 2017, 49(2): 201-205.

ZHANG Yong-jin, LI Jia, QI Ke, XUE Chen-chen, XU Wei-dong. Comparison of efficacy and safety between the anterior and the posterior approaches to total hip arthroplasty[J]. Journal of Peking University(Health Sciences), 2017, 49(2): 201-205.

参考文献

相关文章 15

[1]	李志昌,侯云飞,周之伟,姜龙,张舒,林剑浩. 影响全膝关节置换术患者术前预期的患者因素[J]. 北京大学学报（医学版）, 2022, 54(1): 170-176.
[2]	李伟浩,李伟,张学民,李清乐,焦洋,张韬,蒋京军,张小明. 去分支杂交手术和传统手术治疗胸腹主动脉瘤的结果比较[J]. 北京大学学报（医学版）, 2022, 54(1): 177-181.
[3]	朱正达,高岩,何汶秀,方鑫,刘洋,魏攀,闫志敏,华红. 红色诺卡氏菌细胞壁骨架治疗糜烂型口腔扁平苔藓的疗效及安全性[J]. 北京大学学报（医学版）, 2021, 53(5): 964-969.
[4]	吴浩,潘利平,刘恒,塔拉提百克·买买提居马,王洪彬,宁太国,曹永平. 胫骨假体的不同后倾角度对内侧间室单髁置换术后膝关节功能的影响[J]. 北京大学学报（医学版）, 2021, 53(5): 877-882.
[5]	董寒梅,吴睿麒,高冠英,刘镕阁,徐雁. 关节镜下盂唇重建治疗髋关节撞击综合征12例[J]. 北京大学学报（医学版）, 2021, 53(5): 1007-1011.
[6]	王鑫光,耿霄,李杨,吴天晨,李子剑,田华. 便携式导航与计算机导航辅助在全膝关节置换力线对准和手术时间的比较[J]. 北京大学学报（医学版）, 2021, 53(4): 728-733.
[7]	及松洁,黄野,王兴山,柳剑,窦勇,姜旭,周一新. Oxford膝关节单间室置换术后内翻多因素分析[J]. 北京大学学报（医学版）, 2021, 53(2): 293-297.
[8]	柯岩,张蔷,马云青,李儒军,陶可,桂先革,李克鹏,张洪,林剑浩. 全髋关节置换术治疗脊柱骨骺发育不良患者Tönnis 3级髋关节骨关节炎的早期疗效[J]. 北京大学学报（医学版）, 2021, 53(1): 175-182.
[9]	石茂静,高伟波,黄文凤,朱继红. 61例血栓性血小板减少性紫癜患者的临床分析[J]. 北京大学学报（医学版）, 2021, 53(1): 210-214.
[10]	刘中砥,芦浩,袁玉松,徐海林. Swanson人工跖趾关节置换术治疗第2~5跖趾关节疾病的疗效评价[J]. 北京大学学报（医学版）, 2020, 52(4): 726-729.
[11]	曾保起,于树青,陈瑶,翟伟,刘斌,詹思延,孙凤. 主动脉瓣生物瓣膜安全性的系统评价与meta分析[J]. 北京大学学报（医学版）, 2020, 52(3): 547-556.
[12]	李潇,苏家增,张严妍,张丽琪,张亚琼,柳登高,俞光岩. ¹³¹I相关唾液腺炎的炎症分级及内镜治疗[J]. 北京大学学报（医学版）, 2020, 52(3): 586-590.
[13]	詹颖,杜祎甜,仰浈臻,张春丽,齐宪荣. 紫杉醇微球-原位凝胶的制备及其局部注射的抗肿瘤药效[J]. 北京大学学报（医学版）, 2019, 51(3): 477-486.
[14]	张祎然,饶烽,皮伟,张培训,姜保国. 股骨近端防旋髓内钉与动力髋螺钉治疗不稳定型粗隆间骨折的meta分析[J]. 北京大学学报（医学版）, 2019, 51(3): 493-500.
[15]	张玮,张培训. 老年髋部骨折患者围手术期血栓预防时限分析[J]. 北京大学学报（医学版）, 2019, 51(3): 501-504.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed