直接前方入路与后外侧入路全髋关节置换术的疗效比较

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摘要目的探讨直接前方入路(direct anterior approach，DAA)和后外侧入路(posterior approach，PA)行全髋关节置换术的临床疗效。方法按照纳入排除标准选择我院2013年12月至2016年6月行全髋关节置换术的所有病例，共有128例，分为DAA组(57例)和PA组(71例)。对比分析两组患者手术时间、出血量、下地时间、住院时间，术前、术后1个月及随访时的视觉模拟评分(visual analog scale，VAS)及Harris评分；测量术后髋臼假体的前倾角及外展角，记录术后并发症发生情况。结果 DAA组出血量(232.4±28.6)mL低于PA组出血量(382.3±37.5)mL，DAA组下地时间(1.8±0.7)d低于PA组下地时间(4.3±2.1)d，DAA组住院时间(7.4±1.9)d低于PA组住院时间(9.2±2.3)d，差异均有统计学意义(P＜0.05)。而DAA组的手术时间(112.2±12.6)min长于PA组(98.4±10.3)min，差异有统计学意义(P＜0.05)。DAA组术后1个月VAS评分为(2.3±0.9)分，Harris评分(84.3±4.2)分；PA组术后1个月VAS评分为(2.9±1.3)分，Harris评分(80.6±6.5)分；DAA组优于PA组，差异有统计学意义(P＜0.05)。而随访时DAA组的VAS评分为(1.5±0.8)分，Harris评分(92.2±5.3)分；PA组VAS评分为(1.3±1.1)分，Harris评分为(90.5±6.8)分，两组比较差异无统计学意义(P＞0.05)。DAA组术后假体前倾角(21.3±3.3)°，外展角(39.8±5.4)°；PA组术后假体前倾角(20.6±4.3)°，外展角(41.3±5.0)°，两组比较差异无统计学意义(P＞0.05)。结论直接前方入路全髋关节置换术具有手术出血量小、下地时间早、住院时间短、术后疼痛较轻、假体位置良好等优点，短期临床疗效与后外侧入路均较为满意，长期临床疗效还需进一步随访研究。

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关键词 ：直接前方入路, 后外侧入路, 全髋关节置换术, 前倾角, 外展角

Abstract：Objective To further compare the clinical outcomes of total hip arthroplasty(THA)through direct anterior approach (DAA) and posterior approach (PA).Methods We selected the consecutive cases of THA of our hospital from December 2013 to June 2016 according to the inclusion and exclusion criteria.All the 128 cases was divided into DAA group (57 cases) and PA group (71 cases).And the mean follow-up was 19.6 months.The operative time，blood loss，the leaving bed time，hospital stay，visual analog scale (VAS) and Harris score before operationwere recorded and analyzed.Meanwhile the acetabular anteversion angle and acetabular abduction angle were measured and analyzed.The postoperative complications were recorded.Results The blood loss of the DAA group (232.4±28.6)mL was shorter than the PA group(382.3±37.5)mL (P＜0.05)；the leaving bed time of the DAA group (1.8±0.7)d was shorter than the PA group (4.3±2.1)d (P＜0.05)；the hospital stay of the DAA group was(7.4±1.9)d was shorter than the PA group(9.2±2.3)d (P＜0.05).However，the operative time of the DAA group(112.2±12.6)min was longer than the PA group(98.4±10.3)min (P＜0.05).The VAS score of the DAA group (2.3±0.9)w as lower than the PA group (2.9±1.3) at one month (P＜0.05)，the Harris score of the DAA group (84.3±4.2) was higher than the PA group (80.6±6.5) at one month (P＜0.05).The VAS score was (1.5±0.8) in DAA group and (1.3±1.1) in the PA group.The Harris score was (92.2±5.3) in DAA group and (90.5±6.8) in the PA group，which showed no significant difference between the two groups(P＞0.05).The acetabular anteversion angle was (21.3±3.3)° in DAA group and (20.6±4.3)° in the PA group.The acetabular abduction angle was (39.8±5.4)° in DAA group and (41.3±5.0)° in the PA group，which showed no significant difference between the two groups(P＞0.05).Conclusion Direct anterior approach of THA has less blood loss，earlier get out of the bed，shorter hospital stays less pain and good position of acetabular prosthesis while comparing with PA group.The clinical outcomes are satisfactoryat about 20 months，however，the longer results needed longer follow up studies.

Key words： direct anterior approach posterolateral approach total hip arthroplasty acetabular anteversion angle acetabular abduction angle

通讯作者: 米东

作者简介: 傅维德(1975－ )，男，副主任医师，四川巴中市中心医院骨科，636000。

引用本文:

傅维德，米东 *，张旭，何杰，李德毅. 直接前方入路与后外侧入路全髋关节置换术的疗效比较[J]. 实用骨科杂志, 2018, 24(2): 125-129.
Fu Weide，Mi Dong，Zhang Xu，et al. A Comparative Study on the Clinical Outcomes between Total Hip Arthroplasty by Anterior Approach and Posterior Approach. sygkzz, 2018, 24(2): 125-129.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2018/V24/I2/125

［1］Learmonth ID，Young C，Rorabeck C.The operation of the century：total hip replacement［J］.2007，370(9597)：1508-1519.
［2］Wilmore DW，Kehlet H.Management of patients in fast track surgery［J］.BMJ，2001，322(7284)：473-476.
［3］金大地.关于微创人工全髋关节置换术的若干问题［J］.中华外科杂志，2006，44(8)：509-511.
［4］Widmer KH.A simplified method to determine acetabular cup anteversion from plain radiographs［J］.J Arthroplasty，2004，19(3)：387-390.
［5］Klapach AS，Callaghan JJ，Goetz DD，et al.Charnley total hip arthroplasty with use of improved cementing techniques：a minimum twenty-year follow-up study［J］.J Bone Joint Surg (Am)，2001，83(12)：1840-1848.
［6］Wetters NG，Murray TG，Moric M，et al.Risk factors for dislocation after revision total hip arthroplasty［J］.Clin Orthop Relat Res，2013，471(2)：410-416.
［7］Mccollum DE，Gray WJ.Dislocation after total hip arthroplasty.Causes and prevention［J］.Clin Orthop Relat Res，1990(261)：159-170.
［8］Christensen CP，Jacobs CA.Comparison of patient function during the first six weeks after direct anterior or posterior total hip arthroplasty (THA)：arandomized study［J］.J Arthroplasty，2015，30(9 Suppl)：94-97.
［9］Agten CA，Sutter R，Dora C，et al.MR imaging of soft tissue alterations after total hip arthroplasty：comparison of classic surgical approaches［J］.Eur Radiol，2017，27(3)：1312-1321.
［10］桑伟林，朱力波，陆海明，等.直接前入路与后外侧入路全髋关节置换术的对比研究［J］.中华关节外科杂志(电子版)，2015，9(5)：584-588.
［11］Dienstknecht T，Luring C，Tingart M，et al.Total hip arthroplasty through the mini-incision (Micro-hip) approach versus the standard transgluteal (Bauer) approach：a prospective，randomised study［J］.J Orthop Surg (Hong Kong)，2014，22(2)：168-172.
［12］Batailler C，Fary C，Batailler P，et al.Total hip arthroplasty using direct anterior approach and dual mobility cup：safe and efficient strategy against post-operative dislocation［J］.Int Orthop，2017，41(3)：499-506.
［13］Yue C，Kang P，Pei F.Comparison of direct anterior and lateral approaches in total hip arthroplasty［J］.Medicine，2015，94(50)：e2126.
［14］张江涛，尚延春，吴富源，等.髋关节假体置换中股骨头直径及髋臼前倾角的作用［J］.中国组织工程研究，2013，17(30)：5427-5433.
［15］朱天岳.髓臼外展角和前倾角的动态测量及其临床意义［J］.中华骨科杂志，1995，15(8)：497-499.
［16］Lewinnek GE，Lewis JL，Tarr R，et al.Dislocations after total hip-replacement arthroplasties［J］.J Bone Joint Surg (Am)，1978，60(2)：217-220.