摘要
目的探讨直接前入路（direct anterior approach，DAA）和后外侧入路（posterolateralapproach，PLA）对全髋关节置换术组织损伤及早期功能康复的影响。方法回顾性分析2015年9月至2016年3月68例接受全髋关节置换术患者的资料，男27例，女41例。按手术入路分组：DAA组35例，年龄（54．88±12．13）岁；PLA组33例，年龄（53．18±14．72）岁。比较两组手术切15长度、手术时间、术中出血量、肌酸激酶Serumcreatinekinase，CK）、C反应蛋白（C—reactive protein，CRP）、红细胞沉降率（erythrocyte sedimentation rate，ESR）、白介素．6（interleukin一6，IL．6）、疼痛视觉模拟评分（visu alanaloguescale，VAS）、Harris髋关节功能评分、加利福尼亚大学洛杉矶分校（TheUniversity of Californiaat LosAngeles，UCLA）评分、术后住院时间、步态参数、影像学指标及并发症等。结果DAA组手术切口长度较PLA组短[（11．23±0．97）cm与（15．16±1．12）cm]、手术时间较PLA组长[（73．77±9．20）min与（64．12＋13．31）min]、术中出血量较PLA组大[（157．15±35．83）ml与（126．97±45．45）m1]、术后住院时间较PLA组短[（2．95±0．24）d与（3．35±0．51）d]。DAA组术后CK、CRP、ESR、IL-6值均低于PLA组。术后72h内DAA组疼痛VAS评分低于PLA组，两组差异有统计学意义。两组患者均随访6个月，术后3个月时DAA组Harris髋关节功能评分、UCLA评分及步态参数均优于PLA组，术后6个月两组差异无统计学意义。x线片上髋臼前倾角DAA组（16．4°±2．3°）较PLA组（20．4°±2．80）小。DAA组1例术中出现股骨大转子尖部无移位骨折，PLA组无早期并发症发生。结论DAA全髋关节置换术肌肉损伤小，术后疼痛症状轻，术后住院时间短，早期髋臼假体稳定性更好，更有利于早期髋关节功能康复，但术中出血量大，手术时间相对较长。
Objective To compare faster rehabilitation of different surgical approaches in total hip arthroplasty （THA） patients using a direct anterior approach or posterolateral approach. Methods Sixty-eight patients （35 in direct anterior THA and 33 in posterolateral THA） from September 2015 to March 2016 were recruited in the present study. The incision length, operation duration, intraoperative blood loss, serum creatinekinase （CK）, C-reactive protein （CRP）, erythrocyte sedimentation rate （ESR）, interleukin-6 （IL-5） and visual analogue scale （VAS） pain score were compared between two groups respectively. The Harris hip score, the University of California at Los Angeles （UCLA） pain, walking, and activity scores, postoperative hospital length of stays, gait analysis, component placement and complications were also compared. Results The mean incision length, operation duration, intraoperative blood loss were 11.23±0.97 cm, 73.77±9.20 min and 157.15±5.83 ml in the DAA group respectively, while those in PLA group were 15.16± 1.12 cm, 64.12± 13.31 min and 126.97±45.45 ml. The mean incision length of the DAA group were significantly less than that of the PLA group. The DAA group underwent longer operation time that associated with more intraoperative blood loss. The levels of CK and inflammation markers were increased in the PLA group compared with those in the DAA group. The VAS pain score was less in the DAA group than the PLA group within postoperative 72 hours. Functional recov-ery in the DAA group was faster than that in the PLA group based on the Harris hip score, UCLA scores, and gait analysis up to 3 months. There was no difference in these outcomes between the groups beyond 6 months. The average postoperative hospital length of stay was 2.95±0.24 days and 3.35±0.51 days for the DAA group and PLA group respectively. The patients in DAA group required less postoperative hospital length of stays. The angle of acetabular cup anteversion in the DAA group （16.4°±2.3°） was lesse
作者
赵海燕
夏亚一
康鹏德
聂涌
裴福兴
沈彬
杨静
周宗科
石小军
王浩洋
曾羿
刘欣
Zhao Haiyan XiaYayi Kang Pengde Nie Yong Pei Fuxing Shen Bin Yang Jing Zhou Zongke Shi Xiaojun Wang Haoyang Zeng Yi Liu Xin(Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, China Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou 730030, China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2017年第19期1185-1192,共8页
Chinese Journal of Orthopaedics
基金
国家卫生计生委卫生行业科研专项基金（201302007）
关键词
关节成形术
置换
髋
康复
步态
Arthroplasty, replacement, hip
Rehabilitation
Gait
