目的：前瞻性比较直接前入路（direct anterior approach，DAA）和后外侧保留梨状肌入路(posterolateral piriformissparing approach，Mis-PLA)全髋关节置换的临床疗效。方法： 选自福建省立医院骨科2015 年 3 月至 2016 年2月收入院需行全髋关节置换术的患者，随机分为DAA和Mis-PLA两组。DAA 组（43例45髋）：男 27例 27髋，女16例 18 髋，平均年龄 （57.4±7.3）岁，术前 Harris 评分（41.4±8.7）分，体重指数（body mass index，BMI）为（24.3±2.2） kg/m2；Mis-PLA 组（39例42髋）：男 25 例 26 髋，女 14例 16 髋，平均年龄（59.2 ±7.3）岁，术前 Harris 评分 （39.6±8.4）分， BMI （24.7±2.5） kg/m2。分别对两组的切口长度、手术时间、术中出血量、术后Harris评分、关节功能恢复进行对比评估。结果：（1）两组患者手术切口均Ⅰ/甲级愈合。手术切口长度： DAA组（9.2±0.7） cm,Mis-PLA 组（9.5±0.6） cm，两者间差异无统计学意义（P=0.053）；手术时间：DAA 组(74.3±10.1) min，Mis-PLA组（37.5±4.3） min，两者间差异有统计学意义（P＜0.01）；出血量：DAA组（229.6±79.2） mL，Mis-PLA组（215.7±56.0） mL，两者之间差异无统计学意义（P=0.366）。（2）随访时间6～12个月，术后6 周 Harris 评分:DAA组(85.5±4.1)分,MisPLA组(79.0±4.4)分，两组间差异有统计学意义(P＜0.01)。术后6个月Harris评分，DAA 组(94.3±2.7)分,Mis-PLA 组（95.2±1.9）分，两组间差异无统计学意义(P=0.125)。术后6周髋关节功能评估，DAA组和Mis-PLA组在直线步行速度上差异没有统计学意义（P=0.298），Mis-PLA组上、下楼梯速度优于DAA组(P=0.047)；在转弯速度、坐下、穿袜时，DAA组优于Mis-PLA组（P＜0.01，P=0.016，P＜0.01）。结论： 直接前入路和后外侧保留梨状肌入路的微创全髋关节置换术都能获得满意的临床疗效，后外侧入路的优势在于手术时间短、学习曲线短，直接前入路的主要优势在于术后早期没有体位限制的要求及髋关节功能恢复的更快。

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.