摘要
[目的]比较直接前侧入路与前外侧入路全髋关节置换术的临床疗效。[方法]回顾分析2015年5月~2018年10月本科行单侧初次全髋关节置换术治疗的128例患者的临床资料,其中直接前侧入路63例(DAA组),前外侧入路65例(AL组)。比较两组临床与检验和影像资料。[结果]所有患者均顺利完成手术。DAA组出现1例大转子骨折,术中给予钢丝固定,股外侧皮神经损伤11例;AL组出现3例出现臀中肌无力。DAA组患者切口长度、术中出血量、术后隐性失血量及下床行走时间均显著优于AL组(P<0.05);DAA组术后第1d VAS评分显著低于AL组(P<0.05)。随术后时间推移,两组患者ROM和Harris评分均显著增加(P<0.05)。术后第1个月,DAA组的ROM和Harris评分显著大于AL组(P<0.05);之后,两组间差异无统计学意义(P>0.05)。检验方面,术后3、7d,DDA组的ESR和CRP水平显著低于AL组(P<0.05)。影像方面,术后两组患者股骨颈干角、髋臼外展角和前倾角的差异无统计学意义(P>0.05)。[结论]初次全髋关节置换术采取直接前侧入路比前外侧入路手术创伤小。
[Objective]To compare the clinical outcomes of total hip arthroplasty(THA)through direct anterolateral approach versus anterolateral approach.[Methods]A retrospective study was conducted on 128 patients who underwent primary unilateral total hip arthroplasty in our department from May 2015 to October 2018.Of them,63 patients received THA through direct anterior approach(the DAA group),while the remaining 65 patients had THA through anterolateral approach(the AL group).The clinical,lab test and imaging data were compared between the two groups.[Results]All the patients in both group had operation performed smoothly,despite of 1 case of greater trochanter fracture,and 11 cases of injury to lateral femoral cutaneous nerve in the DDA group,while 3 cases of gluteal weakness in the AL group,all of which did not lead to serious consequences.The DDA group was significantly superior to the AL group regarding to incision length,intraoperative blood loss,postoperative hidden blood loss and ambulation time(P<0.05),additionally the former proved significantly lower VAS score than the latter at early stage after operation(P<0.05).The ROM and Harris score significantly increased over time in both group(P<0.05),which were significantly greater in the DDA group than the AL group at 1 month after operation(P<0.05),and became statistically insignificant afterwards(P>0.05).In term of lab test,the DDA group had significantly lower ERS and CRP than the AL group at 3 and 7 days after operation(P<0.05).However,no statistical difference in femoral neck-shaft angle,acetabular abduction angle and anteversion were noted between the two groups on imaging measurements(P>0.05).[Conclusion]The direct anterolateral approach dose reduce iatrogenic trauma in the primary total hip arthroplasty in comparison with the anterolateral approach.
作者
鲜文峰
钮朋
刘永西
XIAN Wen-feng;NIU Peng;LIU Yong-xi(Department of Orthopedics,Nanyang Second People's Hospital,Nanyang 473012,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2020年第17期1553-1557,共5页
Orthopedic Journal of China
关键词
全髋关节置换术
直接前侧入路
前外侧入路
并发症
total hip arthroplasty
direct anterior approach
anterolateral approach
complication
