侧卧位直接前入路与后外侧入路在单侧全髋中的疗效对比

目的比较侧卧位直接前方入路(L-DAA)与后外侧入路(PLA)在单侧全髋关节置换术中的临床疗效。 方法回顾性分析2016年8月至2017年12月于重庆医科大学附属遂宁市中心医院关节外科行单侧全髋关节置换术患者共93例，纳入初次单侧置换患者，排除双侧或不能耐受手术的患者。按照手术入路不同分为L-DAA组(45例)及PLA组(48例)。所有手术均由同一组医师完成。对两组患者的身体质量指数(BMI)、围手术期各项指标(手术时间、失血量、术前血红蛋白值、术后第1天及第7天血红蛋白值、切口长度、平均住院日)、术前及术后Harris髋关节评分、术前及术后疼痛视觉模拟评分(VAS)等计数资料采用t检验分析；术后影像学评价、术中及术后并发症等计数资料采用卡方检验进行统计学分析。 结果两组患者均获得有效随访，随访时间6～16个月，平均(11.7±1.6)个月。所有患者术后均未出现深静脉血栓、感染等严重并发症。两组在BMI值、术前Harris评分、术前血红蛋白值、手术时间、切口长度、术后影像学评价、术前及术后VAS评分以及平均住院日上差异无统计学意义(P > 0.05)；两组的失血量、术后第1天及第7天血红蛋白值差异具有统计学意义，后外侧入路组的失血量更多，而术后第1天和第7天的血红蛋白值更低(t ＝0.361、0.484，均为P < 0.05)；同时术后3个月患侧Harris髋关节评分L-DAA组高于PLA组(t ＝0.572，P < 0.05)；术后6个月Harris髋关节评分两组差异无统计学意义(P > 0.05)。L-DAA组术后均未发生人工关节脱位，PLA组术后出现2例人工关节后脱位，差异具有统计学意义(χ²＝0.465，P < 0.05)。L-DAA组术中发生2例股骨近端骨折，PLA组术中未发生股骨近端骨折，差异具有统计学意义(X² ＝0.587，P < 0.05)。 结论两种THA手术入路均能取得良好的近期临床疗效，其中L-DAA相较于PLA而言能减少手术创伤，更快恢复日常生活能力，有利于术后早期康复，符合快速康复(ERAS)理念。

Comparative study on direct anterior approach in lateral decubitus position versus posterolateral approach for unilateral total hip arthroplasty

ObjectiveTo compare the clinical efficacy of the direct anterior approach in lateral decubitus position (L-DAA) and posterolateral approach (PLA) for unilateral total hip arthroplasty. MethodsA retrospective study was conducted on 93 patients who underwent primary unilateral total hip arthroplasty in Department of Joint Surgery, Suining Central Hospital between August 2016 and December 2017. The patients who underwent primary unilateral replacement were included and who underwent bilateral replacement or intolerance of surgery were excluded. There were 45 cases underwent L-DAA and 48 cases underwent PLA. The body mass index(BMI), operation time, intraoperative blood loss, preoperative hemoglobin of the postoperative first day and the seventh day, incision length, hospital stay, preoperative and post operative Harris score, preoperative and postoperative VAS score, radiological evaluation, intraoperative and postoperative complication were recorded and analyzed by t test and chi-square test. ResultsAll the patients were followed up for six to 16 months, with an average of (11.7±1.6)months. No deep vein thrombosis, infection or other serious complication occurred. No significant difference was found in BMI, operation time, preoperative Harris score, preoperative Hb, incision length, radiological evaluation, preoperative or postoperative VAS score, nor in hospital stay (P>0.05). Significant differences were detected in intraoperative blood loss, postoperative Hb levels on the first day and the seventh day, more blood loss and lower hemoglobin levels were found in PLA group (t=0.361, 0.484; both P<0.05). In postoperative three months, the Harris score was higher in L-DAA group than PLA group(t=0.572, P<0.05); while in the postoperative six months, there was no significant difference between the two groups(P>0.05). No postoperative complication was found in L-DAA group, while two cases of postoperative hip dislocation were observed in the PLA group, the difference was statistically significant (χ²=0.465, P<0.05). During the operation, two cases of proximal femoral fracture occurred in L-DAA group while non in PLA group (χ²=0.587, P<0.05). ConclusionCompared with the posterolateral approach, the L-DAA approach has the advantages of less trauma and faster postoperative recovery, which is a safe surgical approach and can benefit the rapid rehabilitation of patients.