侧卧位直接前方入路与后外侧入路行全髋关节置换术的疗效分析

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Abstract

Objective To compare the clinical efficacy of the direct anterior approach(DAA) and the posterolateral approach(PLA)for total hip arthroplasty(THA) in the lateral decubitus position.Methods A retrospective study was performed on 102 patients who underwent primary unilateral THA that accepted in the Affiliated Hospital of Southwest Medical University from January 2016 to December 2017.There were 51 cases underwent DAA and 51 cases underwent posterolateral approach.There was no significant difference in gender，age etc.(P＞0.05).The operation time，incision length，intraoperative blood loss，postoperative drainage，acetabulumposition，hospitalization time，postoperative complications and the Harris scores were recorded and compared.Results The patients had an average follow-up of 9.6(range，7~16)months.The operationtime in DAA and PLA was(66.8±11.3) minutes and(62.9±9.2)minutes，respectively.There was no significant difference in operation time between 2 groups(P＜0.05).The incision length in DAA and PLA was(7.2±1.6) cm and(9.8±3.1) cm，respectively.The intraoperative blood loss was(58.3±11.2) mL and(86.8±12.3) mL，respectively.The postoperative drainage was(64.8±12.6) mL and(125.1±11.2)mL，respectively.The hospitalization time was(5.4±1.1) days and(7.8±1.8)days，respectively.There were statistically significant differences between the two groups in incision length，intraoperative blood loss，postoperative drainage and hospitalization time(P＜0.05).The acetabular abduction angle was (38.4±6.2)° in the anterior group and was(37.9±5.7)° in the posterolateralgroup，showing no significant difference(P＞0.05).The acetabularanteversion angle was (17.3±5.3)° in the anterior group and was (18.6±5.1)° in the posterolateral group，showing no significant difference(P＞0.05).Harris scores of DAA was higher than that of PLA group after 1 month and 3 months of operation，the difference was statistically significant(P＜0.05).Harris scores betweenthe two groups had no statistical significance in postoperative 6 months and latest follow-up(P＞0.05).Further analysis，at 3 months after operation，the joint function score in DAA group was significantly higher than that in PLA group(P＜0.05)，while there was no significant difference in the pain score and range of motion score between 2 groups(P＞0.05).VAS of DAA was less than that of PLA after 1 day，3 days，5 days and 7 days of operation，the difference between the two groups was statistically significant(P＜0.05).There were 3 cases(5.8% ) of postoperative dislocation in PLA and no dislocation in DAA.There was 1 case(3.2% ) of lateral femoral cutaneous nerve injury in DAA.Conclusion Compared with the posterolateral approach，the direct anterior approach in the lateral decubitus position in total hip arthroplasty had the advantages of less bleeding，lesspain，faster postoperative recovery at early follow-up.

Key words： lateral decubitus position direct anterior approach posterolateral approach total hip arthroplasty

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[1]	. [J]. sygkzz, 2021, 27(5): 385-387.