摘要
目的 比较侧卧位直接前方入路(DAA)与后外侧入路(PLA)在全髋关节置换术(THA)临床疗效。方法 选取2019年1月至2020年1月期间在本院住院行全髋关节置换的80例患者,按照随机数字表法分为DAA组(40例)和PLA组(40例),比较两组患者的治疗相关指标、髋关节影像学指标、髋关节功能以及术中术后并发症。结果 与PLA组比较,DAA组的切口长度、住院时间短,手术失血量少,术后停止使用助行器早、术后1个月步频快和10米步行测试所用时间短,P<0.05;但两组的手术时长、术后初次下床时间比较无显著差异,P>0.05。DAA组术后1 d、3 d、5 d、1周及1个月VAS评分以及术后血清CRP、肌酸激酶(CK)数值明显低于PLA组,P<0.05。DAA组术后1周、1、3个月HHS评分明显高于PLA组,P<0.05;但两组术后6、12个月HHS评分以及术后1月两组的髋臼外展角、前倾角、双股骨偏心距差和双下肢肢体长度差比较无显著差异,P>0.05。结论 对比PLA,侧卧位DAA行THA创伤更小、功能恢复更快、早期临床疗效更佳,该术式不需要特殊手术床及手术器械等,手术体位更符合大多数骨科医师的习惯,值得在基层医院应用和推广。
Objective The aim of this study was to compare the clinical efficacy of direct anterior approach(DAA) and posterolateral ap-proach(PLA) in total hip arthroplasty(THA). Methods A total of 80 patients who underwent total hip replacement in our hospital from January2019 to January 2020 were included and randomly divided into the DAA group and the PLA group, 40 patients in each group. The clinical outcomes including treatment related indicators, Imaging indicators, hip function, and intraoperative and postoperative complications in both group were record-ed and compared. Results Compared with the PLA group, the DAA group had shorter incision length, shorter hospital stay, less surgical blood loss,earlier postoperative walking without walkers, faster gait frequency 1 month after surgery, and shorter 10-meter walking test time( P<0.05). However,there was no significant difference in surgical time and the time of getting out of bed firstly between the two groups( P>0.05). The VAS scores and postoperative serum CRP and creatine kinase(CK) values in the DAA group were significantly lower than those in the PLA group at 1, 3, 5 days, 1week and 1 month after surgery(P<0.05). The HHS score of DAA group at 1 week, 1 month and 3 months after operation was significantly higher than that of PLA group(P<0.05). However, there were no significant differences in HHS score at 6 and 12 months postoperatively, acetabular abduction angle, anteversion angle, femoral eccentricity difference and limb length difference between the two groups at 1 month after operation( P >0.05).Conclusion Compared with the PLA group, the DAA group has advantages over less trauma, faster functional recovery, and better early clinical effi-cacy. This surgical approach does not require special operating beds and surgical instruments, and the surgical position is more in line with the habits of most orthopaedic surgeons. It is worthy of application and promotion in primary hospitals.
作者
吴伟东
郑翔
吴大华
应锦河
刘瑶
WU Weidong;ZHENG Xiang;WU Dahua(Lishui Central Hospital,Zhejiang 323000,China.)
出处
《浙江创伤外科》
2022年第4期628-631,共4页
Zhejiang Journal of Traumatic Surgery
基金
浙江省丽水市科技计划项目(2019SJZC33)。
关键词
髋关节置换术
侧卧位
直接前方入路
后外侧入路
Hip replacement
Lateral position
Direct anterior approach
Posterolateral approach
