全髋关节置换术中直接前方入路和前外侧入路的疗效对比研究
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摘要
目的探讨全髋关节置换术中直接前方入路和前外侧入路的疗效对比。方法纳入2016年4月—2018年4月52例全髋关节置换术患者,随机分组,每一组有26例。前外侧入路组选择前外侧入路,直接前方入路组选择全髋关节置换术中直接前方入路。分析手术平均时间、开始下床行走时间、手术中出血总量、手术后住院时间、手术切口;治疗前后患者髋关节功能Harris评分、生存质量评分;并发症。结果治疗前两组髋关节功能Harris评分、生存质量评分比较,(P>0.05);治疗后直接前方入路组髋关节功能Harris评分、生存质量评分(93.24±5.55)分、(90.57±5.16)分优于前外侧入路组(81.11±5.21)分、(83.13±3.22)分,(t=6.923,10.433,P<0.05)。直接前方入路组手术平均时间、开始下床行走时间、手术中出血总量、手术后住院时间、手术切口(121.02±2.12)min、(4.02±0.14)d、(125.01±4.61)mL、(5.78±1.68)d、(9.21±1.21)cm优于前外侧入路组(142.14±10.24)min、(6.14±0.24)d,(227.15±23.57)mL、(8.62±2.11)d、(12.62±2.51)cm,(t=5.293、5.211、6.335、5.746、5.768,P<0.05)。直接前方入路组并发症低于前外侧入路组(χ~2=6.234,P<0.05),直接前方入路组并发症中,1例出现髋关节脱位,1例出现皮下血肿,总发生2例,发生率是7.69%。前外侧入路组并发症中,4例出现髋关节脱位,4例出现皮下血肿,2例出现股外侧皮神经损伤,总发生10例,发生率是38.46%。结论全髋关节置换术患者实施全髋关节置换术中直接前方入路可获得较好效果。
Objective To compare the efficacy of direct anterior approach and anterior lateral approach in total hip arthroplasty. Methods A total of 52 patients with total hip arthroplasty were enrolled from April 2016 to April 2018, randomized to 26 patients in each group. The anterior lateral approach group selected the anterolateral approach, and the direct anterior approach group selected the di-rect anterior approach during total hip arthroplasty. The average time of surgery, the time of getting off the bed, the total amount of bleeding during surgery, the length of hospital stay after surgery, and the surgical incision were analyzed. The hip function Harris score and quality of life score before and after treatment were observed. Results The Harris score and quality of life scores of the hips before treatment were compared(P>0.05). After treatment, the hip function Harris score and quality of life score of the direct anterior approach group were(93.24±5.55)points and(90.57±5.16)points, better than the access group was(81.11±5.21)points and(83.13±3.22)points,(t=6.923,10.433,P<0.05). The average time of surgery in the direct anterior approach group, the time to get out of bed,the total amount of bleeding during surgery, the length of hospital stay after surgery, and the surgical incision(121.02 ±2.12)min,(4.02±0.14)d,(125.01±4.61)mL,(5.78±1.68)d,(9.21±1.21)cm better than before the lateral approach group was(142.14±10.24)min,(6.14±0.24)d,(227.15±23.57)mL,(8.62±2.11)d,(12.62±2.51)cm,(t=5.293, 5.211, 6.335, 5.746, 5.768; P<0.05). The anterior approach group had lower complication than before. In the lateral approach group(χ2=6.234, P<0.05). Among the complications of the direct anterior approach group, 1 case had hip dislocation and 1 case had subcutaneous hematoma. The total incidence occurred in 2 cases, the incidence rate was 7.69%. Among the anterior lateral approach complications, 4 cases had hip dislocation, 4 cases had subcutaneous hematoma, and 2 cases had lateral femoral cutaneous nerve injury. There were 10 cases in total, and the incidence rate was 38.46%. Conclusion Direct total anterior approach for total hip arthroplasty in patients undergoing total hip arthroplasty has a better effect.
Objective To compare the efficacy of direct anterior approach and anterior lateral approach in total hip arthroplasty. Methods A total of 52 patients with total hip arthroplasty were enrolled from April 2016 to April 2018, randomized to 26 patients in each group. The anterior lateral approach group selected the anterolateral approach, and the direct anterior approach group selected the di-rect anterior approach during total hip arthroplasty. The average time of surgery, the time of getting off the bed, the total amount of bleeding during surgery, the length of hospital stay after surgery, and the surgical incision were analyzed. The hip function Harris score and quality of life score before and after treatment were observed. Results The Harris score and quality of life scores of the hips before treatment were compared(P>0.05). After treatment, the hip function Harris score and quality of life score of the direct anterior approach group were(93.24±5.55)points and(90.57±5.16)points, better than the access group was(81.11±5.21)points and(83.13±3.22)points,(t=6.923,10.433,P<0.05). The average time of surgery in the direct anterior approach group, the time to get out of bed,the total amount of bleeding during surgery, the length of hospital stay after surgery, and the surgical incision(121.02 ±2.12)min,(4.02±0.14)d,(125.01±4.61)mL,(5.78±1.68)d,(9.21±1.21)cm better than before the lateral approach group was(142.14±10.24)min,(6.14±0.24)d,(227.15±23.57)mL,(8.62±2.11)d,(12.62±2.51)cm,(t=5.293, 5.211, 6.335, 5.746, 5.768; P<0.05). The anterior approach group had lower complication than before. In the lateral approach group(χ2=6.234, P<0.05). Among the complications of the direct anterior approach group, 1 case had hip dislocation and 1 case had subcutaneous hematoma. The total incidence occurred in 2 cases, the incidence rate was 7.69%. Among the anterior lateral approach complications, 4 cases had hip dislocation, 4 cases had subcutaneous hematoma, and 2 cases had lateral femoral cutaneous nerve injury. There were 10 cases in total, and the incidence rate was 38.46%. Conclusion Direct total anterior approach for total hip arthroplasty in patients undergoing total hip arthroplasty has a better effect.
引文
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[8]查小伟,程文丹,吕浩,等.全髋关节置换直接前入路与后外侧入路患者的早期疗效比较[J].中国组织工程研究,2018,22(35).5583-5589
[9]彭永刚,任姜栋,张坤,等.全髋关节置换术经直接前方入路与后方入路临床疗效的Meta分析[J].实用骨科杂志,2018,24(6):510-515.
[10]王瑞,胡成栋,李东风,等.全髋关节置换术中直接前方入路和前外侧入路的疗效对比研究[J].河北医科大学学报,2018,39(11):1270-1274.
[2]邓翔天,刘俊才,李忠,等.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[J].实用骨科杂志,2018,24(8):692-695,700.
[3]Swarup,Ishaan,Lee,et al.Implant Survival and Patient-Reported Outcomes After Total Hip Arthroplasty in Young Patients With Juvenile Idiopathic Arthritis[J].The Journal of arthroplasty,2015,30(3):398-402.
[4]贾宇东,刘又文,王会超,等.直接前方入路与外侧入路全髋关节置换术治疗CroweⅠ、Ⅱ型髋关节发育不良比较研究[J].中国骨与关节杂志,2016,5(7):267-510.
[5]Bisseling,Pepijn,Smolders,et al.Metal Ion Levels and Functional Results Following Resurfacing Hip Arthroplasty Versus Conventional Small-Diameter Metal-on-Metal Total Hip Arthroplasty,a 3 to 5 year Follow-Up of a Randomized Controlled Trial[J].The Journal of arthroplasty,2015,30(1):61-67.
[6]刘宇,桑伟林,姜亚飞,等.直接前方入路与后外侧入路行人工全髋关节置换术对髋臼假体位置影响的比较研究[J].中国修复重建外科杂志,2017,31(7):790-793.
[7]朱力波,马金忠,桑伟林,等.直接前方入路人工全髋关节置换术的中期疗效研究[J].中国修复重建外科杂志,2017,31(9):13-17.
[8]查小伟,程文丹,吕浩,等.全髋关节置换直接前入路与后外侧入路患者的早期疗效比较[J].中国组织工程研究,2018,22(35).5583-5589
[9]彭永刚,任姜栋,张坤,等.全髋关节置换术经直接前方入路与后方入路临床疗效的Meta分析[J].实用骨科杂志,2018,24(6):510-515.
[10]王瑞,胡成栋,李东风,等.全髋关节置换术中直接前方入路和前外侧入路的疗效对比研究[J].河北医科大学学报,2018,39(11):1270-1274.