直接前方入路全髋关节置换术治疗强直性髋关节炎

目的探讨直接前方入路全髋关节置换术在治疗强直性髋关节炎中的临床效果。 方法回顾性分析2015年10月至2018年10月于福建省立医院行全髋关节置换术的强直性髋关节炎62例(66髋)，纳入强直性脊柱炎合并髋关节炎行全髋关节置换的患者，排除脊柱畸形严重患者。根据手术入路分为直接前入路组和后外侧入路组，比较手术切口长度，术中出血量的差异，通过Harris髋关节功能评分、影像学评价两组患者手术效果。计量资料采用t检验，计数资料采用卡方检验。 结果直接前入路组和后外侧入路组在手术切口长度和术中出血量的差异无统计学意义(t＝1.346、1.272,均为P>0.05)。末次随访平均(25±11)个月，所有患者均解除疼痛，恢复髋关节活动功能。直接前入路组Harris评分术前平均(61±14)分，术后平均(97.8±2.9)分。后外侧入路组Harris评分术前平均(59.3±14.3)分，术后平均(97.4±3.3)分。两组组内术后Harris评分均明显高于术前(t＝14.229、14.729, P<0.001)，但两组间差异无统计学意义(t ＝0.416, P>0.05)。术后X线片两组均无骨溶解及假体松动等征象，未发生术后并发症。 结论直接前方入路全髋关节置换治疗强直性髋关节炎的临床效果满意。

Total hip arthroplasty via direct anterior approach in treatment of ankylosed hips

ObjectiveTo evaluate the clinical outcomes of total hip arthroplasty via direct anterior approach in the treatment of ankylosed hips. MethodsA retrospective analysis was performed on the data of 62 patients (66 hips) treated with total hip arthroplasty for ankylosed hips from October 2015 to October 2018 in Fujian Provincial Hospital. The patients with ankylosing spondylitis and hip arthritis were included and the patients with severe spinal deformity were excluded. According to the surgical approach, the patients were divided into direct anterior approach group and posterolateral approach group. The incision length, bleeding volume, Harris score and X-ray evaluation were used to evaluate the hip function of the two groups. Chi-square test was performed in count data and t test was used for measurement data. ResultsNo significant differences were found in incision length and bleeding volume between the two groups(t=1.346, 1.272, both P>0.05). In the latest follow-up for an average of (25±11) months, all patients were relieved of pain. In the direct anterior approach group, the preoperative average Harris score was (61±14)and the postoperative average score was (97.8±2.9). In the posterolateral approach group, the preoperative average Harris score was (59.3±14.3)and the postoperative average score was (97.4±3.3). The postoperative average Harris score was significantly superior to the preoperative average score in both two groups (t=14.229, 14.729, P<0.001). However, there was no significant differences between the two groups (t=0.416, P>0.05). There was no osteolysis and loosening signs in X-ray in both two groups and no complication was found during the follow-up. ConclusionThe clinical outcomes of total hip arthroplasty via direct anterior approach in the treatment of ankylosed hips are satisfactory.