Tang Yanfeng, Li Hongjun, Liu Youwen, Yang Yuxia, Li Wuyin, Cai Hongmin
Department of Hip Injury, Luoyang Orthopedic Traumatological Hospital of Henan Province (Henan Province Orthopedic Hospital), Luoyang Henan, 471002, P.R.China.
Department of Hip Injury, Luoyang Orthopedic Traumatological Hospital of Henan Province (Henan Province Orthopedic Hospital), Luoyang Henan, 471002,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Oct 15;31(11):1300-1304. doi: 10.7507/1002-1892.201705078.
To compare the short-term effectiveness of staged bilateral total hip arthroplasty via different approaches.
Thirty-two patients (64 hips) with bilateral hip disease were treated with total hip arthroplasty between January 2012 and December 2014. There were 20 males and 12 females with the mean age of 45.3 years (range, 30-67 years). There were avascular necrosis of femoral head in 14 cases, developmental dislocation of the hip in 12 cases, ankylosing spondylitis in 4 cases, osteoarthritis in 2 cases. All patients were treated with total hip arthroplasty; and the direct anterior approach (DAA) or direct lateral approach (DLA) was chosen for the unilateral hip randomly. The length of incision, operation time, total blood loss volume, the time of first postoperative activity, and the acetabular anteversion angle were compared. The Harris score, visual analogue scale (VAS) score, and incidence of complication were compared between 2 groups.
All incisions healed at stage Ⅰ. All patients were followed up 20-53 months (mean, 39.6 months). The length of incision, total blood loss volume, the time of first postoperative activity were significantly shorter in DAA group than in DLA group ( <0.05). The operation time was significantly longer in DAA group than in DLA group ( <0.05). There was no significant difference in acetabular anteversion angle between 2 groups ( =1.122, =0.266). The incidence of complication were 25.00% and 15.63% in DAA group and DLA group, respectively, showing no significant difference ( =0.869, =0.536). The Harris score in DAA group significantly increased at 3 and 9 months after operation than in DLA group ( <0.05); there was no significant difference at 18 months after operation between 2 groups ( >0.05). The VAS score was significantly lower in DAA group than in DLA group at 1 day, 3 days, and 1 week after operation ( <0.05); there was no significant difference at 4 and 8 weeks between 2 groups ( >0.05). The prosthesis did not loosen and sink during the follow-up.
Total hip arthroplasty via DAA can reduce operation related complication and speed up the recovery of hip function at the early stage after operation. However, the lateral cutaneous nerve injury is the most common complication.
比较不同入路分期双侧全髋关节置换术的短期疗效。
2012年1月至2014年12月期间，32例（64髋）双侧髋关节疾病患者接受了全髋关节置换术。其中男性20例，女性12例，平均年龄45.3岁（范围30 - 67岁）。股骨头缺血性坏死14例，发育性髋关节脱位12例，强直性脊柱炎4例，骨关节炎2例。所有患者均接受全髋关节置换术；单侧髋关节随机选择直接前路（DAA）或直接外侧入路（DLA）。比较两组的切口长度、手术时间、总失血量、术后首次活动时间及髋臼前倾角。比较两组的Harris评分、视觉模拟量表（VAS）评分及并发症发生率。
所有切口均Ⅰ期愈合。所有患者均获随访20 - 53个月（平均39.6个月）。DAA组的切口长度、总失血量、术后首次活动时间均显著短于DLA组（P<0.05）。DAA组的手术时间显著长于DLA组（P<0.05）。两组髋臼前倾角差异无统计学意义（F =1.122，P =0.266）。DAA组和DLA组的并发症发生率分别为25.00%和15.63%，差异无统计学意义（χ² =0.869，P =0.536）。DAA组术后3个月和9个月的Harris评分显著高于DLA组（P<0.05）；术后18个月两组差异无统计学意义（P>0.05）。DAA组术后1天、3天和1周的VAS评分显著低于DLA组（P<0.05）；术后4周和8周两组差异无统计学意义（P>0.05）。随访期间假体未松动下沉。
经DAA行全髋关节置换术可减少手术相关并发症，加速术后早期髋关节功能恢复。然而，股外侧皮神经损伤是最常见的并发症。
