Chen Chang, Yin Yiran, Juncai Liu, Chen Ge
Department of Orthopaedics, Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province, China.
Arthroplasty. 2020 Jul 29;2(1):21. doi: 10.1186/s42836-020-00040-w.
Compared to the posterior approach (PA), the direct anterior approach (DAA) can achieve better clinical outcomes for total hip arthroplasty (THA). The purpose of this study was to investigate whether the same advantages associated with the DAA could be attained in patients undergoing simultaneous bilateral THA.
We retrospectively reviewed 89 patients who underwent one-stage bilateral THA through the DAA (group A, n = 46) and through the PA (group B, n = 43) between June 2015 and November 2017 at our institution. The patients were followed up for a minimum of 1 year. There were no significant differences in gender, age, body mass index (BMI), preoperative hemoglobin level, preoperative Harris hip score (HHS), and preoperative visual analogue scale (VAS) score between the two groups (P > 0.05 for all).
The incision length, operation time, intraoperative blood loss, blood transfusion volume, and the length of stay (LOS) were significantly less in group A than in group B (p < 0.05). The surgery-related complications were not significantly lower in group A (5.43%) than in group B (10.47%) (χ = 2.209, p = 0.112). In 46 cases in group A, one hip had an acetabular anteversion higher than normal value. In both groups, one hip developed aseptic loosening. The HHS was significantly higher in group A than in group B 1, 3, 12 month(s) after operation (p < 0.05). The VAS was significantly lower in group A than in group B 1, 3, 12 month(s) after operation. Against the simple Likert scale, comprehensive satisfaction was significantly higher in group A (97.8%, 45/46) than in group B (76.7%, 33/43) (χ = 9.119, p = 0.003).
In patients who underwent simultaneous bilateral THA, DAA could significantly relieve pain, accelerate the functional recovery of hip joint and improve the satisfaction more than PA. In clinical practice, however, more attention should be paid to strict compliance to operative indications and the prevention of early complications. The long-term effectiveness warrants further observation.
与后入路（PA）相比，直接前入路（DAA）在全髋关节置换术（THA）中可取得更好的临床效果。本研究旨在调查在同期双侧THA患者中是否能获得与DAA相关的相同优势。
我们回顾性分析了2015年6月至2017年11月在我院通过DAA（A组，n = 46）和PA（B组，n = 43）接受一期双侧THA的89例患者。对患者进行了至少1年的随访。两组在性别、年龄、体重指数（BMI）、术前血红蛋白水平、术前Harris髋关节评分（HHS）和术前视觉模拟量表（VAS）评分方面无显著差异（所有P>0.05）。
A组的切口长度、手术时间、术中出血量、输血量和住院时间（LOS）均显著少于B组（p<0.05）。A组的手术相关并发症（5.43%）并不显著低于B组（10.47%）（χ=2.209，p = 0.112）。A组46例中，一侧髋关节的髋臼前倾角高于正常值。两组均有一侧髋关节发生无菌性松动。术后1、3、12个月，A组的HHS显著高于B组（p<0.05）。术后1、3、12个月，A组的VAS显著低于B组。根据简单李克特量表，A组的综合满意度（97.8%，45/46）显著高于B组（76.7%，33/43）（χ=9.119，p = 0.003）。
在同期双侧THA患者中，DAA比PA能显著缓解疼痛，加速髋关节功能恢复并提高满意度。然而，在临床实践中，应更加注意严格遵守手术适应症和预防早期并发症。长期疗效有待进一步观察。
