Li S L, Yang X T, Tian X B, Sun L
Department of Orthopaedics, Guizhou Provincial people's Hospital, Guiyang 550002, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2019 Apr 18;51(2):268-272. doi: 10.19723/j.issn.1671-167X.2019.02.013.
To evaluate the early clinical effects of direct anterior approach (DAA) versus anterolateral approach (ALA) on safety and functional recovery following total hip arthroplasty (THA).
Between January 2015 and May 2016, a randomized clinical trial was performed at Guizhou Provincial People's Hospital. A total of 50 patients who underwent THA were allocated for either the DAA (n=25) or ALA (n=25). DDA group had 25 patients (25 hips), including 16 males and 9 females, with the mean age of (62±2) years, BMI of (23.26 ±4.95) kg/m(range: 19.6 to 29.5), and preoperative Harris score of (33.4 ±15.5) (range: 17.9 to 48.9). Eleven cases were diagnosed as primarily hip osteoarthritis, 4 were developmental dysplasia of the hip (DDH, Crowe 2) and 10 were hip avascular necrosis (AVN, Stages 3 to 4). ALA group had 25 patients (25 hips), including 18 males and 7 females, with the mean age of (59±3) years, BMI of (25.35 ±5.8) kg/m(range: 18.2 to 29.8), and preoperative Harris score of (38.6 ± 16.7) (range: 23.1 to 56.5). Ten cases were diagnosed as primarily hip osteoarthritis, 3 were developmental dysplasia of the hip (DDH, Crowe 2) and 12 were hip avascular necrosis (AVN, Stages 3 to 4). Operation time, incision length, intra-operative blood loss and functional recovery of hip postoperatively were compared between the two groups.
The surgical incision of both groups were stage I healing. The mean follow-up was 6 months. There was no significant difference regarding operation time, incision length, and intra-operative blood loss between the two groups. However, we also found that there was no significant difference in the Harris score 3 months and 6 months postoperatively. In addition, two patients in ALA group suffered claudication (physical examination: abduction dysfunction of hip). We also found that DAA group resulted in better recovery of abductor strength and gait than ALA group during early follow-up.
Both DAA and ALA could obtain good results of early curative effect following THA. Moreover, DAA resulted in better gait than ALA during early follow-up.
评估全髋关节置换术（THA）后直接前路（DAA）与前外侧入路（ALA）对安全性和功能恢复的早期临床效果。
2015年1月至2016年5月期间，在贵州省人民医院进行了一项随机临床试验。共有50例行THA的患者被分配至DAA组（n = 25）或ALA组（n = 25）。DDA组有25例患者（25髋），其中男性16例，女性9例，平均年龄（62±2）岁，体重指数（BMI）为（23.26±4.95）kg/m（范围：19.6至29.5），术前Harris评分为（33.4±15.5）（范围：17.9至48.9）。11例被诊断为原发性髋骨关节炎，4例为发育性髋关节发育不良（DDH，Crowe 2型），10例为股骨头缺血性坏死（AVN，3至4期）。ALA组有25例患者（25髋），其中男性18例，女性7例，平均年龄（59±3）岁，BMI为（25.35±5.8）kg/m（范围：18.2至29.8），术前Harris评分为（38.6±16.7）（范围：23.1至56.5）。10例被诊断为原发性髋骨关节炎，3例为发育性髋关节发育不良（DDH，Crowe 2型），12例为股骨头缺血性坏死（AVN，3至4期）。比较两组的手术时间、切口长度、术中出血量及术后髋关节功能恢复情况。
两组手术切口均为Ⅰ期愈合。平均随访6个月。两组在手术时间、切口长度和术中出血量方面无显著差异。然而，我们还发现术后3个月和6个月的Harris评分也无显著差异。此外，ALA组有2例患者出现跛行（体格检查：髋关节外展功能障碍）。我们还发现，在早期随访期间，DAA组的外展肌力和步态恢复优于ALA组。
DAA和ALA在THA后均可获得良好的早期疗效。此外，在早期随访期间，DAA的步态优于ALA。
