直接前方入路与后外侧入路在全髋置换术中的疗效比较

Comparison of efficacy of direct anterior approach and posterior lateral approach in total hip arthroplasty

摘要:

目的研究直接前方入路（DAA）在全髋置换术（THA）中的应用疗效及经验总结。方法共纳入156例首次THA 患者，其中82 例采用后外侧入路（PLA），74 例采用DAA，对比临床疗效。结果两组的手术时间比较，差异无统计学意义（p >0.05），DAA组的术中出血、术后引流时间和引流量减小，与PLA 组比较，差异有统计学意义（p <0.05）。两组围术期并发症发生率比较，差异无统计学意义（p >0.05）。DAA 组术后1、3 和7 d 疼痛评分低于PLA 组，差异有统计学意义（p <0.05）。DAA 组的部分下地负重、完全负重时间和总住院时间较PLA组缩短，差异有统计学意义（p <0.05）。DAA 组术后1、3 和6 个月Harris 髋关节功能评分高于PLA 组，术后6 个月DAA 组髋关节功能优于PLA组，差异有统计学意义（p <0.05）。结论THA 采用DAA 手术创伤更小，疼痛减轻，早期功能锻炼时间缩短，髋关节功能改善更佳，有较好的应用安全性和有效性。

Abstract:

Objective To study the efficacy and experience of direct anterior approach (DAA) for total hip arthroplasty (THA). Methods A total of 156 consecutive patients who accepted THA for the first time were selected for the study. Among them 82 cases chose posterior lateral approach (PLA) and 74 adopted DAA. Then the clinical effect was compared. Results The operation time in the two groups had no statistical difference (p > 0.05), while the blood loss during operation and the drainage volume were smaller, the drainage time after operation was shorter in the DAA group (p < 0.05). The perioperative complications were not statistically different between the two groups (p >0.05). The pain score of the DAA group was significantly lower than that of the PLA group 1, 3 and 7 d after operation (p < 0.05). The partial and total loading time，and the total stay-in hospital days were shorter in the DAA group (p < 0.05). The Harris score of hip joint function was significantly higher in the DAA group 1, 3 and 6 m after operation, and the hip joint function of the DAA group was better than that of the PLA group 6 m after operation (p <0.05). Conclusions DAA for total hip arthroplasty has the advantages of less injury, milder pain, shorter time to start early functional exercises, better improvement of hip joint function. It is greatly safe and effective.