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

Abstract

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

CLC Number:

R687.4

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.

Figures/Tables 7

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Table 1

Statistical result of operation time, incision length, and intra-operative blood loss comparing DAA and ALA for total hip arthroplasty"

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

Table 1

Table 2

Table 3

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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

Early functional recovery of direct anterior approach versus anterolateral approach for total hip arthroplasty

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