Zhao Ming, Hu Yihe, Zeng Min, Zhong Da, Xie Jie
Department of Orthropaedics, Xiangya Hospital of Central South University, Changsha Hunan, 410008, P.R.China.
Department of Orthropaedics, Xiangya Hospital of Central South University, Changsha Hunan, 410008,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Jan 15;31(1):11-16. doi: 10.7507/1002-1892.201608111.
To evaluate the short-term effectiveness of minimally invasive total hip arthroplasty (THA) by direct anterior approach (DAA).
Between January and August 2014, THA was performed on 48 patients (60 hips) by DAA (group A), and on 72 patients (92 hips) by posterolateral approach (group B). There was no significant difference in gender, age, etiology, course, and preoperative visual analogue scale (VAS), Harris hip score (HHS), and hip range of motion (ROM) between 2 groups ( >0.05). The operation time, intraoperative blood loss, postoperative drainage, hospitalization time, incision healing, and complications were recorded and compared. The acetabular abduction and anteversion were measured on the X-ray films; prosthesis loosening was observed. The VAS score, HHS score, and hip ROM were used to evaluate the hip function.
The operation time and intraoperative blood loss of group A were significantly higher than those of group B, and the hospitalization time was significantly lower than group B ( <0.05), but no significant difference was found in postoperative drainage between 2 groups ( =0.71, =0.46). The patients were followed up 2-2.5 years (mean, 2.2 years) in group A, and 2-2.5 years (mean, 2.1 years) in group B. In group A, 3 cases had lateral femoral cutaneous nerve traction injury and 1 case had swelling and exudate, and primary healing of incision was obtained in the other cases of group A and all cases of group B. No periprosthetic joint infection occurred in the others of groups A and B except 1 case of group A at 2 months after operation, and infection was controlled after debridement, irrigation, and intravenous infusion of Vancomycin for 1 month. The X-ray films showed good position of prosthesis and no obvious radiolucent line or prosthesis loosening. There was no significant differences in acetabular abduction and anteversion between groups A and B at last follow-up ( >0.05). The VAS score, HHS score, and hip ROM at 3 months and last follow-up were significantly better than preoperative ones in 2 groups ( <0.05), but no significant difference was found between at 3 months and last follow-up ( >0.05). The VAS score, HHS score, and hip ROM in group A were significantly better than those in group B at 3 months postoperatively ( <0.05). At last follow-up, the hip ROM in group A was significantly better than that in group B ( <0.05), and there was no significant difference in VAS and HHS scores between group A and group B ( >0.05).
The short-term effectiveness of minimally invasive THA by DAA is satisfactory, with the advantage of little trauma, short hospital stay, and rapid postoperative recovery.
评估直接前路微创全髋关节置换术（THA）的短期疗效。
2014年1月至8月，48例患者（60髋）采用直接前路行THA（A组），72例患者（92髋）采用后外侧入路行THA（B组）。两组患者在性别、年龄、病因、病程、术前视觉模拟评分（VAS）、Harris髋关节评分（HHS）及髋关节活动度（ROM）方面差异无统计学意义（P>0.05）。记录并比较两组患者的手术时间、术中出血量、术后引流量、住院时间、切口愈合情况及并发症。于X线片上测量髋臼外展角及前倾角；观察假体松动情况。采用VAS评分、HHS评分及髋关节ROM评估髋关节功能。
A组手术时间及术中出血量显著高于B组，住院时间显著低于B组（P<0.05），但两组术后引流量差异无统计学意义（P=0.71，P=0.46）。A组患者随访2 - 2.5年（平均2.2年），B组患者随访2 - 2.5年（平均2.1年）。A组3例出现股外侧皮神经牵拉伤，1例出现肿胀及渗出，A组其他病例及B组所有病例切口均一期愈合。A、B组除A组1例术后2个月发生假体周围关节感染外，其余患者均未发生，经清创、冲洗及静脉滴注万古霉素1个月后感染得到控制。X线片显示假体位置良好，无明显透亮线或假体松动。末次随访时，A、B组髋臼外展角及前倾角差异无统计学意义（P>0.05）。两组术后3个月及末次随访时的VAS评分、HHS评分及髋关节ROM均显著优于术前（P<0.05），但术后3个月与末次随访时差异无统计学意义（P>0.05）。术后3个月时，A组的VAS评分、HHS评分及髋关节ROM显著优于B组（P<0.05）。末次随访时，A组髋关节ROM显著优于B组（P<0.05），A、B组VAS及HHS评分差异无统计学意义（P>0.05）。
直接前路微创THA短期疗效满意，具有创伤小、住院时间短及术后恢复快的优点。
