体位对直接前方入路全髋关节置换术的影响

目的：探讨术中不同体位对直接前方入路（direct anterior approach，DAA）全髋关节置换术的影响。方法：回顾性分析2016年7月至2020年6月行DAA全髋关节置换术患者94例，根据术中不同体位分为2组，其中侧卧位45例，仰卧位（支架辅助下）49例。观察比较两组患者性别、患肢、身体质量指数（body mass index，BMI）等一般资料，切口长度、手术时间、术中出血量、术后24 h引流量、手术前后血红蛋白差值、术后首次下地时间、术后住院时间、术后并发症，术后1 d，1、2周，1、3、6个月的疼痛视觉模拟评分（visual analogue scale，VAS），术后1、2周及1、3、6个月的Harris评分。结果：两组患者术后均获得随访，时间6~12（8.31±2.22）个月。两组患者的性别、手术部位、年龄、BMI、术前VAS、术前Harris评分比较差异无统计学意义（P>0.05）。仰卧位（支架辅助下）组患者切口长度、手术时间、术中出血量、术后24 h引流量、手术前后血红蛋白差值、术后首次下地时间和术后住院时间均优于侧卧位组（P<0.05）；术中、术后输血例数比较，差异无统计学意义（P=0.550）。仰卧位（支架辅助下）组术中和术后前倾角、外展角比较，差异无统计学意义（P=0.825，P=0.066）；侧卧位组术中和术后前倾角、外展角比较，差异有统计学意义（P<0.05）。仰卧位（支架辅助下）组患者术后1 d，1、2周，1个月VAS低于侧卧位组（P<0.05），两组术后3、6个月VAS差异无统计学意义（P>0.05）。仰卧位（支架辅助下）组患者术后1周及1、3个月的Harris评分高于侧卧位组（P<0.05），两组术后6个月的Harris评分比较，差异无统计学意义（P>0.05）。结论：仰卧位（支架辅助下） DAA全髋关节置换术与侧卧位术式相比，手术切口小、手术时间短、出血少、下地时间早、住院时间短，且术中髋臼杯位置判断误差小，具有术后恢复快的优势，但在6个月后患者的髋关节功能恢复是相同的。

Effect of posture on total hip arthroplasty through direct anterior approach

Objective To investigate the effect of different postures on direct anterior approach(DAA) total hip arthroplasty.Methods Total of 94 patients who underwent DAA total hip arthroplasty from July 2016 to June 2020 were retrospectively analyzed. They were divided into two groups according to different positions during the operation, including 45 cases in lateral position and 49 cases in supine position (with the aid of stent). The general data such as gender, affected limb, body mass index(BMI), incision length, operation time, intraoperative bleeding volume, drainage volume 24 hours after operation, hemoglobin difference before and after operation, first landing time after operation, postoperative hospitalization time, postoperative complications, visual analogue scale(VAS) at 1 day, 1, 2 weeks, 1, 3 and 6 months after operation, Harris score at 1, 2 weeks, 1, 3 and 6 months after operation were observed and compared between the two groups.Results Patients in both groups were followed up for 6 to 12 months with an average of (8.31±2.22) months. There was no significant difference between two groups in gender, affected limb, age, height, weight, body mass index(BMI), preoperative VAS score and preoperative Harris score(P>0.05). The incision length, operation time, intraoperative bleeding volume, 24-hour drainage volume, hemoglobin difference before and after operation, first time to the ground and postoperative hospitalization time of patients in supine position (assisted by stent) group were all better than those in lateral position group(P<0.05);There was no significant difference in the number of blood transfusions during and after operation(P=0.550). There was no significant difference in anteversion angle and abduction angle in the supine position(with the aid of stent) group during and after operation (P=0.825, P=0.066);There was significant difference in anteversion angle and abduction angle in the lateral position group during and after operation(P<0.05). VAS of patients in supine position (assisted by stent) group were lower than those in lateral position group at 1 day, 1, 2 weeks and 1 month after operation(P<0.05), and there was no statistical difference between two groups at 3 and 6 months after operation(P>0.05). Harris scores of patients in supine position(assisted by stent) group were higher than those in lateral position group at 1 week, 1 month and 3 months after operation(P<0.05), and there was no significant difference between two groups at 6 months after operation(P>0.05).Conclusion Compared with the lateral position, the supine position DAA total hip arthroplasty has the advantages of small incision, short operation time, less bleeding, early landing time, short hospitalization time, and small intraoperative acetabular cup position judgment error. It has the advantage of fast postoperative recovery, but the recovery of hip joint function is the same after 6 months.