[直接前路全髋关节置换术的中期疗效]
[Mid-term effectiveness of total hip arthroplasty by direct anterior approach].
作者信息
Zhu Libo, Ma Jinzhong, Sang Weilin, Lu Haiming, Wang Cong, Jiang Yafei
机构信息
Department of Orthopaedics, Shanghai First People's Hospital Affiliated Shanghai Jiaotong University, Shanghai, 201620, P.R.China.
Department of Orthopaedics, Shanghai First People's Hospital Affiliated Shanghai Jiaotong University, Shanghai, 201620,
出版信息
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Sep 15;31(9):1031-1035. doi: 10.7507/1002-1892.201705011.
OBJECTIVE
To retrospectively compare the mid-term effectiveness between by direct anterior approach (DAA) and by posterolateral approach in total hip arthroplasty (THA).
METHODS
Between January 2009 and December 2010, 110 patients (110 hips) treated with THA and followed up more than 5 years were chosen in the study. THA was performed on 55 patients by DAA (DAA group), and on 55 patients by posterolateral approach (PL group). There was no significant difference in gender, age, body mass index, types of hip joint disease, and preoperative Harris score between 2 groups ( >0.05). The operation time, amount of bleeding, length of hospital stay, postoperative complications, and the Harris scores were recorded and compared.
RESULTS
There was no significant difference in operation time and length of hospital stay between 2 groups ( =0.145， =0.876; =1.305, =0.093). The amount of bleeding was significantly less in DAA group than in PL group ( =2.314, =0.032). All patients were followed up 5-7 years (mean, 5.97 years). Complications happened in 5 cases (9.1%) of DAA group and in 3 cases (5.5%) of PL group, and there was no significant difference in the incidence of complications between 2 groups ( =0.539， =0.463). There was significant difference in Harris scores at 6 months after operation between 2 groups ( =2.296, =0.014), but no significant difference was found in Harris score at 1 year and 5 years between 2 groups ( =1.375, =0.130; =0.905, =0.087). Further analysis, at 6 months after operation, the joint function score in DAA group was significantly higher than that in PL group ( =1.087, =0.034), while there was no significant difference in the pain score and range of motion score between 2 groups ( =1.872, =0.760; =1.059, =0.091).
CONCLUSION
THA by DAA has the advantages of less bleeding and faster recovery. The short-term effectiveness is superior to the THA by traditional posterolateral approach, but there is no obvious advantage in the mid-term effectiveness.
目的
回顾性比较全髋关节置换术（THA）中直接前路（DAA）与后外侧入路的中期疗效。
方法
选取2009年1月至2010年12月行THA且随访超过5年的110例患者（110髋）。55例患者采用DAA行THA（DAA组），55例患者采用后外侧入路（PL组）。两组患者在性别、年龄、体重指数、髋关节疾病类型及术前Harris评分方面差异无统计学意义（>0.05）。记录并比较手术时间、出血量、住院时间、术后并发症及Harris评分。
结果
两组手术时间和住院时间差异无统计学意义（=0.145，=0.876；=1.305，=0.093）。DAA组出血量明显少于PL组（=2.314，=0.032）。所有患者随访5 - 7年（平均5.97年）。DAA组5例（9.1%）发生并发症，PL组3例（5.5%）发生并发症，两组并发症发生率差异无统计学意义（=0.539，=0.463）。两组术后6个月Harris评分差异有统计学意义（=2.296，=0.014），但术后1年和5年Harris评分差异无统计学意义（=1.375，=0.130；=0.905，=0.087）。进一步分析，术后6个月，DAA组关节功能评分明显高于PL组（=1.087，=0.034），而两组疼痛评分和活动范围评分差异无统计学意义（=1.872，=0.760；=1.059，=0.091）。
结论
DAA行THA具有出血少、恢复快的优点。短期疗效优于传统后外侧入路的THA，但中期疗效无明显优势。
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