后方入路髋关节置换术和直接前方入路髋关节置换术用于全髋关节置换的疗效比较

目的 比较后方入路髋关节置换术（direct posterolateral approach,PLA）和直接前方入路髋关节置换术（direct anterior approach,DAA）用于全髋关节置换的效果。方法 选择2020年1月至2021年1月首都医科大学附属北京朝阳医院怀柔医院收治的初次单侧全髋关节置换术患者62例,根据治疗方法分为DDA组31例和PLA组31例。比较围术期指标及治疗前和治疗后1个月、6个月患者视觉模拟评分（visual analogue scale,VAS）及Harris髋关节功能评分（Harris hip score,HHS）;比较患者治疗后1周、1个月、3个月、6个月Berg平衡量表评分（Berg balance scale,BBS）。结果 DAA组手术时间、住院时间低于PLA组,差异有显著性（P<0.05）;两组术中失血量、髋臼前倾角、髋臼外展角差异无显著性（P>0.05）。两组不同时间下组内VAS评分差异有显著性（F=2073.404,P=0.000）;两组患者静息状态下VAS评分差异有显著性（F=68.542,P=0.000）;两组静息...     

人工全髋关节置换直接前入路与后外侧入路的临床疗效比较

对比人工全髋关节置换直接前入路与后外侧入路的临床疗效。选取在我院行全髋关节置换治疗的患者84例,按随机数表法分为对照组和观察组,各42例。对照组采用后外侧入路,观察组采用直接前入路,比较两组手术相关指标、Harris评分及并发症情况。观察组术中出血量、手术时间及术后下床活动时间[(124.1±29.5)ml、(77.5±23.7)min、(10.8±5.3)h]均低于对照组[(153.8±10.8)ml、(109.8±25.7)min、(18.9±7.3)h],差异有统计学意义(P0.05);观察组术后1个月、2个月人工全髋关节疗效评分标准(Harris)评分[(82.5±4.3)分、(86.3±5.2)分]明显高于对照组[(73.9±8.6)分、(80.1±5.1)分],差异有统计学意义(P0.05);术后3个月,观察组Harris评分和对照组比较,差异无统计学意义(P0.05);两组患者术后均未出现明显并发症。与后外侧入路全髋关节置换术比较,直接前入路可缩短患者手术时间及住院时间,快速恢复患者髋关节功能。     

直接前方入路与后外侧入路全髋关节置换术治疗股骨头坏死的临床疗效分析

目的：探讨直接前方入路（DAA）与后外侧入路（PLA）全髋关节置换术（THA）治疗股骨头坏死（ONFH）的临床疗效。方法：回顾性分析2017年1月至2020年12月收治的66例ONFH患者的临床资料,根据手术入路不同分为PLA组30例和DAA组36例,比较两组患者手术相关指标以及术后第1、3、7天疼痛程度[采用视觉模拟评分（VAS）评估],术后6个月、12个月时Harris评分（HHS）。结果：DAA组术中出血量、术后引流量少于PLA组（P＜0.05）,手术切口长度、首次下床时间、住院时间短于PLA组（P＜0.05）,但手术时间长于PLA组（P＜0.05）。两组患者术前HHS各分项评分、VAS评分比较,差异无统计学意义（P＞0.05）;术后第1、3、7天,DAA组患者VAS评分低于PLA组（P＜0.05）;术后6个月、末次随访时,两组HHS各项评分均高于术前（P＜0.05）,DAA组功能、疼痛、活动范围评分高于PLA组（P＜0.05）;末次随访时,两组HHS各项评分比较,差异无统计学意义（P＞0.05）。结论：与PLA比较,DAA-THA治疗ONFH对患者术后早期髋关节功能、活动度和疼痛均有较好的改善作用,且手术创伤小,术中出血量和术后引流量少,有利于术后快速恢复,缩短术后康复时间和住院时间。     

直接前方入路髋关节置换术治疗老年骨质疏松股骨颈骨折的疗效分析

目的 探讨直接前方入路(DAA)全髋关节置换术(THA)治疗老年骨质疏松股骨颈骨折的疗效。方法 选取2020年6月至2022年6月40例老年骨质疏松股骨颈骨折患者,随机分为直接前方入路(DAA)组,传统后外侧入路(PLA)组,每组各20例。比较两组患者切口长度、术中出血量、手术时间、术后24 h引流量、术后首次下地时间、术后住院时间、炎症指标[白细胞计数(WBC)、C反应蛋白(CRP)、肝素结合蛋白(HBP)、血沉(ESR)]、肌肉损伤指标[肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、乳酸脱氢酶(LDH)]、视觉模拟评分(VAS)、双侧下肢长度差值、Berg平衡量表(BBS)、髋关节功能评分(HHS)、牛津髋关节评分(OHS)及术后并发症发生率。结果 与PLA组相比较,DAA组切口长度、术中出血量、术后24 h引流量、术后首次下地时间、术后住院时间、炎症指标、肌肉损伤指标、VSA评分均低于PLA组(P<0.05);DAA组术后1、3、6个月HHS、BBS、OHS评分均高于PLA组(P<0.05)。结论 与PLA全髋关节置换术相比,DAA具有手术创伤小更小,术后炎症反应更轻...     

侧卧位直接前入路与后外侧入路行全髋关节置换早期疗效的Meta分析

目的 对侧卧位直接前入路与后外侧入路行全髋关节置换的早期治疗效果进行系统性分析。方法 从Pubmed、Embase、Cochrane Library、中国生物医学文献数据库、中国知网、万方、维普数据库中计算机检索建库至2021年12月的相关文献。筛选符合标准的文献并评价偏倚风险后进行Meta分析。结果 本次研究共纳入文献10篇,共计814例患者。与后外侧入路相比,侧卧位直接前入路的手术时间较长[MD=6.42,95%CI(0.51,12.33),P<0.05],切口较小[MD=-2.32,95%CI(-3.25,-1.38),P<0.01],术中出血量少[MD=-68.11,95%CI(-100.33,-35.90),P<0.01],术后引流量少[MD=-41.29,95%CI(-62.25,-20.32),P<0.01],住院时间短[MD=-2.98,95%CI(-4.91,-1.04),P<0.01],术后1周内总的VAS评分较低[MD=-0.76,95%CI(-0.96,-0.55),P<0.01],术后6个月内总的髋关节Harris评分较高[...     

小切口前外侧入路及后外侧入路在初次全髋关节置换术患者中的应用效果比较

目的比较小切口前外侧入路及后外侧入路在初次全髋关节置换术患者中的应用效果。方法将100例初次全髋关节置换术患者根据随机抓阄法分为对照组和观察组,各50例。对照组采用小切口后外侧入路,观察组采用小切口前外侧入路。比较两组的治疗效果。结果治疗后,两组的Harris评分均升高,VAS评分均降低,且观察组优于对照组(P<0.05)。观察组的髋臼外展角、髋臼前倾角、偏心距均优于对照组,并发症总发生率低于对照组(P<0.05)。结论前外侧入路、后外侧入路均可获取一定效果,但对于初次全髋关节置换术患者,采用小切口前外侧入路更利于术后恢复。     

微创直接前入路与后外侧小切口入路行初次全髋关节置换术疗效的Meta分析

目的系统评价微创直接前入路(direct anterior approach,DAA)与后外侧小切口入路(posterior lateral approach,PLA)行初次全髋关节置换术的临床疗效。方法计算机检索Cochrane图书馆、中国生物医学数据库、Pubmed、SCI、Embase、维普信息数据库、万方数据库、中国期刊全文数据库CNKI,收集国内外DAA与PLA行初次全髋关节置换术的文献,检索时限为1966年1月至2017年6月。由两名研究者独立进行文献筛选、资料提取和纳入研究的偏倚风险评价后,提取疗效评价相关指标(手术时间、术中出血量、手术切口长度、住院时间及术后并发症、髋关节HHR评分、髋关节脱位情况),采用RevMan5.2软件进行Meta分析。结果共纳入12个研究,总病例数3877例,其中DAA组2085例,PLA组1792例。经Meta分析,与PLA组比较,DAA组手术时间(SMD=1.74、95%CI:1.08~2.40、P<0.000 01)显著增加,术中出血量(SMD=-2.65、95%CI:-4.18~-1.13、P=0.000 7)、手术切口长度(SMD=-1.83、95%CI:-3.36~-0.30、P=0.02)、住院时间(SMD=-1.54、95%CI:-2.28~-0.80、P<0.000 1)、术后髋关节HHR评分(SMD=0.53、95%CI:0.04~1.01、P=0.03)均显著减少;2组术后并发症、髋关节脱位发生率比较差异均无统计学意义(OR=1.06、0.28,95%CI:0.59~1.92、0.07~1.05,P=0.84、0.06)。结论与后外侧小切口入路相比,微创直接前入路行初次全髋关节置换术在术中出血量、手术切口长度、住院时间、术后髋关节HHR评分方面具有明显优势,但在术后并发症与髋关节脱位发生率方面二者无明显差异。     

外侧小切口髋关节前入路初次人工全髋关节置换术疗效分析

目的:比较外侧小切口髋关节前入路与后外侧入路在初次人工全髋关节置换术中的效果及优缺点。方法:选取2009年3月至2011年3月在我院初次单侧人工全髋置换40例,随机分为外侧小切口髋关节前入路组(A组)和后外侧入路组(B组),每组20例。比较两组切口长度,手术时间,术中出血量、术后引流量,下床行走时间及术前、术后髋关节Harris评分。结果:A组切口长度,手术时间,术中出血量、术后引流量,下床行走时间,术后早期(1个月)髋关节Harris评分均优于B组(P<0.05),差异有明显统计学意义。术后晚期(6个月)Harris评分无明显差异(P>0.05)。结论:外侧小切口髋关节前入路在初次人工全髋关节置换术中组织损伤小,出血少,术后恢复快,是初次人工全髋关节置换术较好的入路方式。     

前外侧小切口与常规后外侧切口全髋关节置换的疗效对比

背景：目前国内全髋关节置换以后外侧入路传统手术为主,损伤大,恢复慢,小切口手术未普及运用,前外侧小切口入路手术报道极少,临床RCT研究几乎空白。目的：对比前外侧小切口与传统后路切口全髋关节置换的临床疗效。方法：选择2008-06/2009-09在南京医科大学附属无锡人民医院行全髋关节置换的患者共102例,随机分实验组（n=55）和对照组（n=47）,分别采用前外侧小切口和传统后路切口方法进行全髋关节置换。结果与结论：与对照组相比,实验组患者全髋关节置换的伤口小,手术时间短,术中出血少（P〈0.05）,置换后早期（2周,3个月）Harris评分高（P〈0.05）,但2组置换后髋臼外展角和不良事件发生率接近（P〉0.05）,且置换后6个月,1年时Harris评分差异无显著性意义（P〉0.05）。说明前外侧小切口全髋关节置换能在不影响临床疗效的前提下能够减轻手术创伤、缩短手术时间、减少出血、减轻置换后疼痛,置换后早期功能恢复快,是一种安全可靠有效的方法。     

Outcomes after inpatient rehabilitation of primary and revision total hip arthroplasty

OBJECTIVE: To compare the outcomes of patients who have gone to inpatient rehabilitation after primary total hip arthroplasty (THA) and revision THA. DESIGN: Retrospective, comparative study. SETTING: Fifty-bed freestanding, university-affiliated rehabilitation hospital. PARTICIPANTS: Two hundred fifty-five male and female primary THA patients and 147 male and female revision THA patients. INTERVENTION: Interdisciplinary inpatient rehabilitation. MAIN OUTCOME MEASURES: Length of stay (LOS), FIM instrument score and FIM motor score components, hospital charges, and discharge disposition location. RESULTS: FIM scores improved from admission to discharge by 29.7 and 27.9 points for the primary THA and revision THA groups, respectively (P<.05). LOS was shorter for primary THA patients compared with revision THA patients (10.0d vs 11.5d, P<.05). FIM efficiency (DeltaFIM/LOS) was greater for primary THA compared with revision THA (3.4 and 2.7 points/day, P<.05). Total rehabilitation hospital charges were 11,421 US dollars and 13,707 US dollars for the primary and revision THA groups, respectively, with the mechanical and infection revision THAs incurring the greatest charges (14,596 US dollars and 15,386 US dollars, respectively; P<.001). Compared with primary THA, revision THA patients were twice as likely to be discharged to locations other than home. CONCLUSIONS: FIM score improvement was lower and LOS and hospital charges were greater in revision THA than in primary THA after rehabilitation. Infection revision THA patients gained less functional independence and were discharged home less often than mechanical or pain revision THA patients; finally, infection and mechanical revision THA accrued the highest hospital charges.     

Direct anterior approach for total hip arthroplasty using the fracture table

Total hip arthroplasty is a successful procedure for treatment of painful hip arthritides. A large volume of literature is devoted to the patient outcomes and complication profiles of the commonly used surgical approaches to help refine the technique, enhance patient function, and limit cost and patient morbidity. The direct anterior approach has been reported using a fracture table to promote surgical exposure to the proximal femur. This technique is described herein with attention paid to the technical points which facilitate surgical exposure, patient safety, and functional outcome. Following a literature review of recent reports using this procedure are reviewed in context of the reported complications. The results show the direct anterior approach using a fracture table performed by experienced surgeons is an effective technique which provides early postoperative function and reduces the risk of dislocation.     

Two-year gait analysis controls of the minimally invasive total hip arthroplasty by the direct anterior approach

BackgroundThe purpose of the study was to determine the long-term functional outcome of two hip approaches by gait analysis. Patients were selected by prospective randomization, and operated on either by the anterolateral approach or by a minimally invasive direct anterior approach.Methods33 patients (17 anterolateral approach; 16 direct anterior approach) were analyzed using a Vicon 870 system. Gait analysis was performed two years after total hip arthroplasty. Temporo-spatial and kinematic variables were obtained.FindingsOn chest and pelvic kinematics, no patient group demonstrated significant differences. The time-distance parameters showed significant differences with the anterior approach in cadence and stride time.InterpretationThe study indicates that the direct anterior approach exerts positive effects compared with the anterolateral approach two years after surgery. The muscle-sparing concept of direct anterior approach results in significant differences in gait compared to the anterolateral approach 2 years after surgery.     

全髋置换术中微创后外侧小切口的应用分析

目的比较微创后外侧小切口全髋置换术和传统的常规全髋置换术的疗效,并研究微创后外侧小切口全髋置换术在临床应用上的优缺点。方法 72例全髋关节置换患者随机分入两组,观察组36例采用微创后外侧小切口全髋置换术,对照组36例采用常规全髋置换术。记录患者的性别、年龄、体重、手术时间、术中失血量及术后引流量、切口长度、术中术后骨折、术后开始功能锻炼时间、术后Harris评分、并发症等,随访时间为3～18个月,平均12个月。结果观察组在术中术后失血量、手术切口长度、术后开始功能锻炼时间显著低于对照组,在术后Harris评分、术后并发症等无显著性差异。结论采用微创后外侧小切口全髋置换术进行人工全髋置换术明显缩短手术时间和降低术后并发症及假体位置不当的风险,具有手术创伤小、失血量少、可以早期进行关节功能锻炼等优点。     

电子量角器结合个性化测量板在直接前入路全髋关节置换术中的应用

目的 探讨使用电子量角器和个性化测量板在直接前入路(DAA)全髋关节置换术(THA)中的作用。方法回顾性分析2017年1月至2019年12月复旦大学附属金山医院骨科采用DAA入路进行THA的180例193髋初次全髋关节置换病例。其中，136髋使用电子量角器和个性化测量模板(模板组)，57髋采用常规手术(常规组)，两组患者随访时间、年龄、性别、体质量差异无统计学意义。记录两组手术时间、术后臼杯外展角、前倾角、肢体长度差异、髋关节活动度、髋关节功能HHS评分及并发症情况。结果 两组手术时间差异无统计学意义(t=0.34,P>0.05)，末次随访模板组术后髋关节HHS评分优于常规组(t=6.16,P<0.05)，且并发症发生率小于常规组(χ²=4.64,P<0.05)。模板组和常规组髋臼假体外展角、前倾角、髋关节屈曲、后伸、外旋、内旋、内收、外展差异均有统计学意义，模板组优于常规组(P<0.05)。两组之间肢体长度差异无统计学意义。随访期间均无假体感染、松动发生。结论 DAA入路结合电子量角器和个性化测量板可以提高DAA入路THA髋臼假体放置的精...     

Gait asymmetry following an anterior and anterolateral approach to total hip arthroplasty

Background

Patients with osteoarthritis of the hip demonstrate a limp while ambulating, and persistent asymmetric limb loading following unilateral total hip arthroplasty might induce further complications in the affected and contralateral limbs. The purpose of this study was to investigate pre- to postsurgical changes in gait symmetry in patients receiving either an anterior or anterolateral hip replacement.

Methods

Three-dimensional kinematic and kinetic gait analyses were performed on 12 patients undergoing anterior surgery, 11 patients undergoing anterolateral surgery and 10 age-matched controls while level walking. A two-way mixed model analysis of variance with repeated measures was utilized to determine differences in symmetry indices and pelvic obliquity between groups and across time.

Findings

At presurgery, greater single limb support time and step length asymmetry was demonstrated by both patient groups when compared to controls. While the anterior hip replacement patients demonstrated greater improvement in gait symmetry by 6 weeks postsurgery, both patient groups approached control levels by 16 weeks postsurgery. No significant differences were seen between patient groups for pelvic obliquity, limb loading or temporal-distance symmetry at any time point.

Interpretation

Patients undergoing either anterior or anterolateral hip replacement enhanced their gait symmetry by 16 weeks following surgery. Improvement in gait symmetry at 6 weeks postsurgery, as compared to presurgery, was detected in patients undergoing anterior hip replacement. However, no such improvement was observed in patients receiving the anterolateral approach. Findings of this study highlight the potential impact of surgical approach on short-term changes in gait asymmetry.     

全髋关节置换后的康复训练程序

背景：全髋关节置换后的康复训练对置换后患者肢体康复起非常重要的作用。目的：回顾分析全髋关节置换后康复训练程序的组成、方法、效果评价、发展及存在的问题。方法：以＂全髋关节置换,康复,物理治疗,功能锻炼＂为中文关键词,以＂totalhip arthroplasty;total hip replacement;physical rehabilitation;rehabilitation trainning＂为英文关键词,采用计算机检索CNKI和Medline数据库1996-01/2012-02关于全髋关节置换后康复训练的文章。结果与结论：全髋关节置换后的康复训练内容主要以体位护理、运动疗法为主,并可配合以人工按摩及磁疗、电疗、超声波疗法等。采用运动疗法时,要注意循序渐进原则,由最初的被动运动,逐渐过渡到主动运动。根据手术类型、假体种类、患者情况等选择合适的康复训练程序可明显提高患者患侧髋关节功能恢复的速度和质量。