摘要
目的分析比较侧卧位直接前方入路(DAA)与直接外侧入路(DLA)全髋关节置换的效果,为制订手术方案提供参考。方法选取滕州市中心人民医院2020年6月—2023年6月收治的行全髋关节置换术治疗的股骨颈骨折和股骨头坏死患者260例作为观察对象,按照入路术式不同分为对照组和观察组各130例。对照组实施侧卧位DLA,观察组实施侧卧位DAA。比较两组并发症发生率、双下肢长度差、髋臼外展角、切口长度、术中出血量、住院天数、疼痛程度、髋关节功能恢复情况。结果观察组并发症发生率低于对照组,但差异无统计学意义(P>0.05)。观察组双下肢长度差、髋臼外展角为(4.14±1.12)mm、(38.11±2.25)°,均小于对照组的(6.54±1.45)mm、(40.14±2.78)°,差异均有统计学意义(t=14.935、6.472,P<0.05)。观察组切口长度小于对照组,术中出血量少于对照组,住院天数短于对照组,差异均有统计学意义(P<0.05)。观察组术后1周VAS评分低于对照组,术后3个月Harris评分、髋关节外展肌力矩高于对照组,差异均有统计学意义(P<0.05)。结论在全髋关节置换术中,侧卧位DAA入路要优于DLA入路,可缩小双下肢长度差,减轻疼痛,促进髋关节功能恢复,具有微创性、易于推广等优点,值得临床推广应用。
Objective To analyze and compare the effects of direct anterior approach(DAA)and direct lateral approach(DLA)for total hip arthroplasty in lateral decubitus position,providing reference for formulating surgical plans.Methods A total of 260 patients with femoral neck fractures and femoral head necrosis who underwent total hip arthroplasty at Tengzhou Central People's Hospital from June 2020 to June 2023 were selected as the observation subjects,according to different surgical approaches,the patients were divided into control group and observation group,with 130 cases in each group.The control group underwent lateral decubitus position DLA,while the observation group underwent lateral decubitus position DAA.The incidence of complications,difference in length of both lower limbs,acetabular abduction angle,incision length,intraoperative bleeding volume,length of hospital stay,degree of pain,and hip joint function recovery between two groups were compared.Results The incidence of complications in the observation group was lower than that in the control group,but the difference was not statistically significant(P>0.05).The length difference of both lower limbs and acetabular abduction angle of the observation group were(4.14±1.12)mm and(38.11±2.25)°,respectively,which were smaller than those of the control group with(6.54±1.45)mm and(40.14±2.78)°,and the differences were statistically significant(t=14.935,6.472,P<0.05).The incision length in the observation group was shorter than that in the control group,intraoperative bleeding volume was less than that in the control group,and the length of hospital stay was shorter than that in the control group,and the differences were statistically significant(P<0.05).The VAS score of the observation group 1 week after surgery was lower than that of the control group,while the Harris score and hip abductor muscle torque 3 months after surgery were higher than those of the control group,and the differences were statistically significant(P<0.05)Conclusion In total hip arthroplasty,the lateral decubitus position DAA approach was superior to the DLA approach,as it could reduce the length difference of both the lower limbs,alleviate pain and promote hip joint function recovery.It had the advantages of minimally invasive and easy to promote,and was worthy of clinical promotion and application.
作者
马健
孔德宝
康立新
杜庚衡
MA Jian;KONG De-bao;KANG Li-xin;DU Geng-heng(Department of Joint Sports Medicine,Tengzhou Central People's Hospital,Tengzhou Shandong Province 277599,China)
出处
《中国城乡企业卫生》
2025年第4期12-15,共4页
Chinese Journal of Urban and Rural Enterprise Hygiene
关键词
侧卧位直接前方入路
直接外侧入路
全髋关节置换
股骨颈骨折
股骨头坏死
并发症
双下肢长度差
Lateral decubitus position direct anterior approach
Direct lateral approach
Total hip arthroplasty
Femoral neck fracture
Femoral head necrosis
Complications
Difference in length of both lower limbs
