摘要
[目的]探讨微创直接前方入路(direct anterior approach,DAA)的学习曲线,比较其不同时期与前外侧入路进行初次全髋关节置换术(total hip arthroplasty,THA)的早期临床疗效。[方法]回顾2015年6月~2017年6月,本院76例初次THA患者,分为DAA前期组25例、后期组26例以及前外侧入路(anterior lateral approach,ALA)组25例,比较3组在手术切口长度、手术时间及出血量、术前及术后6、12、24周Harris评分、髋臼假体外展角及前倾角的区别。[结果]DAA前期组手术切口长度、手术时间及出血量明显大于DAA后期组(P<0.05),术后6、12周Harris评分DAA前期组明显不及后期组(P<0.05),髋臼假体外展角及前倾角DAA前期组大于后期组(P<0.05);两个DAA组较ALA组手术切口长度小、出血量少,但手术时间长(P<0.05),术后6、12周Harris评分两个DAA组均优于ALA组(P<0.05),但术后24周Harris评分3组差异无统计学意义(P>0.05)。两个DAA组的髋臼假体外展角及前倾角较ALA组偏大(P<0.05),但均在正常范围内。[结论]DDA学习曲线在25例左右,之后手术技术更趋于成熟与稳定,能有效缩短手术时间,减少出血量及并发症,与ALA手术相比提高患者早期疗效。
[Objective] To explore the short-term results and learning curve of the direct anterior approach（DAA） for total hip arthroplasty（THA） compared among those at different stages of DAA applied and the anterior lateral approach（ALA）.[Methods] We conducted a retrospective study on 76 patients who underwent primary THA from June 2015 to June 2017 in our hospital. In term of stages of DAA applied in our department, the 76 patients were divided into 3 groups, including 25 patients in the earlier DAA group, 26 patients in the later DAA group, and the remaining 25 patients in the ALA group as a condition control. The incision length, operation time and blood loss, additionally the Harris score, as well as the acetabular abduction angle and anteversion angle radiologically measured were compared among the 3 groups. [Results] The earlier DAA group was significantly more than the later DAA group in incision length, operation time and blood loss（P〈0.05）. In addition, the former also proved lower Harris scores at 6 and 12 weeks postoperatively（P〈0.05）, in opposition, accompanied with greater abduction and anteversion angles than the latter（P〈0.05）. Compared with those of the ALA group, both the DAA groups got statistically reduced incision length and blood loss, conversely increased operation time（P〈0.05）, in addition, improved Harris scores at 6 and 12 weeks after operation（P〈0.05）, despite the fact that no statistical differences were noted among the 3 groups at 24 weeks postoperatively. In addition, both the DAA groups proved significantly higher acetabular abduction and anteversion angles than the ALA group, although all the parameters were in the normal range. [Conclusion] Surgical techniques tend to be matured and stable after 25 cases of THA performed through the DAA in learning curve, which do effectively shorten the operation time, reduce bleeding and complications as well as improve the early clinical outcomes compared with the operation through ALA.
作者
张旭辉
黎丹东
李坛
夏磊
王世海
ZHANG Xu-hui;LI Dan-dong;LI Tan(Department of Joint Surgery, Joint Trauma Center of PLA, the 371^st Hospital of PLA;Department of Joint Surgery, The 371^st Hospital affiliated to Xinxiang Medical University Xinxiang 453000, China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2018年第8期707-711,共5页
Orthopedic Journal of China
关键词
直接前方入路
前外侧入路
全髋置换术
早期疗效
direct anten＇ior approach （DAA） , anterior lateral approach （ALA） , total hip arthroplasty （THA） , short-term outcome
