关键词: 关节成形术, 置换, 髋, 直接前入路, 微创外科手术, 后外侧保留梨状肌入路

Abstract:

Objective： To compare the clinical effects of direct anterior approach (DAA) and posterolateral piriformis-sparing approach (Mis-PLA) for minimally invasive surgery of total hip arthroplasty. Methods: The patients who had total hip arthroplasty from March 2015 to February 2016 were randomly divided into 2 groups: DAA group and Mis-PLA group. In the study, 43 patients (45 hips) were performed with total hip replacement via the direct anterior approach (DAA group). As comparison，39 patients (42 hips) were performed with total hip replacement via the posterolateral piriformis-sparing approach （Mis-PLAgroup） at the same period. DAA group：27 male patients (27 hips), and 16 female patients (18 hips)，with an average age of (57.4±7.3) years, preoperative Harris score (41.4±8.7), body mass index（BMI）(24.3±2.2) kg/m2; MisPLA group： 25 male patients (26 hips)，14 female patients (16 hips), with an average age of (59.2±7.3) years, preoperative Harris score (39.6±8.4), BMI (24.7±2.5) kg/m2. The length of incision， operation time， blood loss，postoperative Harris score were observed and specially the hip functional recovery was fully assessed. Results: (1) All the incisions healed by first intention. No complications were found in both groups. The length of incision：DAA group :（9.2±0.7） cm and Mis-PLA group :（9.5±0.6） cm. No statistical significant differences were found (P=0.053). The operation time：DAA group （74.3±10.1） min and Mis-PLA group（37.5±4.3） min, which showed statistically significant differences（P＜0.01）. Blood loss：DAA group（229.6±79.2） mL and Mis-PLA group (215.7±56.0) mL. Nostatistical significant differences were found （P=0.366）. (2) The patients in both groups were followed up for 6-12 months. The Harris hip scores for 6 weeks’ follow-up：(85.5±4.1) in DAA group and (79.0±4.4) in Mis-PLA group，which indicated statistically significant differences (P＜0.01).The Harris scores for the 6-month follow-up：(94.3±2.7) in DAA group and (95.2±1.9) in Mis-PLA group. No statistically significant differences were found (P=0.125). The basic daily hip function analysis for the 6-week follow-up：walking speed: no statistically significant differences were found between the two groups（P=0.298）; Climbing stairs: Mis-PLA group’ outcome was better than DAA group’s with statistical differences (P=0.047); Circling,sitting and wearing shoes and socks: outcomes in DAA group exceeded Mis-PLA group’s with statistically significant differences （P＜0.01，P=0.016，P＜0.01）. Conclusion: Total hip arthroplasty through either DAA or Mis-PLA approaches could result in very satisfactory clinical effect. Comparing with DAA, Mis-PLA requires less operation time, shorter learning curve，which indicates that it is a relatively safer approach. The advantages of total hip arthroplasty through direct anterior approach lie in less positional limitation in the early stage of postoperative period，as well as a faster recovery of hip function.

Key words: Arthroplasty, replacement, hip, Direct anterior approach, Minimal surgical procedures, Posterolateral piriformis-sparing approach