Araújo Paulo, Machado Luís, Cadavez Duarte, Mónaco Lisete, Januário Filipa, Luís Lisete, Bártolo Mafalda
Serviço de Medicina Física e de Reabilitação. Centro Hospitalar de Leiria. Leiria. Portugal; Serviço de Ortopedia. Centro Hospitalar de Leiria. Leiria. Portugal; Faculdade de Psicologia e de Ciências da Educação. Universidade de Coimbra. Coimbra. Portugal.
Serviço de Ortopedia. Centro Hospitalar de Leiria. Leiria. Portugal.
Acta Med Port. 2017 Sep 29;30(9):623-627. doi: 10.20344/amp.7834.
To assess the function and quality of life in patients undergoing total hip arthroplasty distinguishing two surgical approaches (posterior / anterolateral) used by the Orthopedics department of Centro Hospitalar de Leiria.
Retrospective study of 94 patients subject to unilateral hip replacement surgery, using the 'Hip Osteoarthritis Outcome Score' (HOOS LK 2.0) questionnaire, the Trendelenburg test and evaluation of muscle strength of the hip abductor muscles with dynamometer. Patients were evaluated at six months, 12 months, 18 months and 24 months after surgery.
The study revealed that 97.9% patients completed the rehabilitation program. The postoperative evolution (six to 24 months) does not appear to have any differences in results when comparing both approaches. At six months the patient operated by the anterolateral approach showed worse results when compared with the posterior approach, in particular in Hip Osteoarthritis Outcome Score pain, in Hip Osteoarthritis Outcome Score symptoms and Hip Osteoarthritis Outcome Score activities of daily living. After 24 months, no differences between the two surgical approaches were found. Of the 94 patients evaluated, the Trendelenburg test was positive in 31% of patients of which 81.9% corresponds to patients operated by the anterolateral approach. Muscle strength of the abductors of the operated hip was clearly lower in the anterolateral approach at six months, 12 months, and 24 months.
This study showed that, in the first six months after total hip arthroplasty, the patients operated by the posterior approach were, according to the HOOS questionnaire, less symptomatic, and presented with better quality of life and less impact on activities of daily living and in sport and leisure when compared with the patients operated by the anterolateral approach. However, these differences were matched over the 24 months. Moreover, the results of muscle strength of the abductor muscles of the hip were clearly superior in patients operated by the posterior approach at six months, at 12 months and at 24 months compared to the patients operated by the anterolateral approach.
After 24 months post total hip arthroplasty there are no differences between the two approaches with regard to function or quality of life. However, the patients operated by the anterolateral approach had greater muscle strength deficits and higher percentage of positive Trendelenburg test.
为评估莱里亚中心医院骨科采用的两种手术入路（后侧/前外侧）进行全髋关节置换术患者的功能和生活质量。
对94例接受单侧髋关节置换手术的患者进行回顾性研究，使用“髋关节骨关节炎结果评分”（HOOS LK 2.0）问卷、特伦德伦伯格试验以及用测力计评估髋关节外展肌的肌力。在术后6个月、12个月、18个月和24个月对患者进行评估。
研究显示97.9%的患者完成了康复计划。比较两种手术入路时，术后6至24个月的结果似乎没有差异。在6个月时，与后侧入路相比，前外侧入路手术的患者结果较差，尤其是在髋关节骨关节炎结果评分疼痛、髋关节骨关节炎结果评分症状和髋关节骨关节炎结果评分日常生活活动方面。24个月后，未发现两种手术入路之间存在差异。在94例接受评估的患者中，31%的患者特伦德伦伯格试验呈阳性，其中81.9%为前外侧入路手术的患者。在6个月、12个月和24个月时，前外侧入路手术髋关节的外展肌肌力明显较低。
本研究表明，在全髋关节置换术后的前六个月，根据HOOS问卷，与前外侧入路手术的患者相比，后侧入路手术的患者症状较少，生活质量更好，对日常生活活动以及运动和休闲的影响较小。然而，在24个月内这些差异消失。此外，与前外侧入路手术的患者相比，后侧入路手术的患者在6个月、12个月和24个月时髋关节外展肌的肌力明显更好。
全髋关节置换术后24个月，两种手术入路在功能或生活质量方面没有差异。然而，前外侧入路手术的患者肌肉力量缺陷更大，特伦德伦伯格试验阳性率更高。
