全髋关节置换术中直接前方入路与后外侧入路的疗效及安全性分析

目的：比较初次全髋关节置换术中直接前方入路（direct anterior approach，DAA）和后外侧入路（posterior approach，PA）的临床疗效和安全性。方法： 回顾性分析2015年7-12月期间收治的初次全髋关节置换术患者92例，分为DAA组44例，PA组48例，随访时间7~13个月，平均10.2个月。比较2组手术时间、住院时间、出血量、髋臼假体位置、术后停止使用助行器时间、Harris 髋关节功能评分、并发症等。使用软件SPSS 13.0 对两组数据进行分析比较。结果： DAA组与PA组年龄［（58.0±11.9）岁vs.（61.0±10.4）岁］、体重指数（25.1±3.7 vs.24.7±3.3）差异均无统计学意义（P>0.05）。DAA组与PA组手术时间无明显区别［（76.0±17.4） min vs.（71.0±14.3） min，P>0.05］，但住院时间明显缩短［（3.8±1.7） d vs.（4.9±2.3） d，P<0.05］，出血量明显减少［（238.0±55.3） mL vs. （387.0±61.2） mL，P<0.05］。髋臼位置方面，DAA组和PA组髋臼前倾角（17.3°±5.3° vs.18.6°±5.1°）、髋臼外展角（38.5°±5.7° vs. 37.7°±5.2°）差异均无统计学意义（P>0.05）。DAA组使用助行器时间明显缩短［（24.6±7.8） d vs.（31.7±10.2） d，P<0.05］，术后6周随访时DAA组Harris评分更高［85.7±5.4 vs.81.3±6.1，P<0.05］，但末次随访时两组间Harris评分差异无统计学意义（93.4±4.7 vs.92.3±5.3，P>0.05）。DAA组出现1例（2.2%）大转子骨折，1例（2.2%）股外侧皮神经损伤，未出现脱位病例；PA组出现1例（2.1%）髋关节后脱位，1例（2.1%）腹股沟区疼痛。两组均未出现假体松动、下肢深静脉血栓、坐骨神经损伤等并发症。结论： 全髋关节置换术中直接前方入路明显比后外侧入路疼痛轻、出血量少、下床时间早、住院时间短、假体位置更佳，短期效果肯定，可获得快速康复及良好的关节稳定性。

Comparison of efficacy and safety between the anterior and the posterior approaches to total hip arthroplasty

Objective:To compare the efficacy and safety between direct anterior approach (DAA) and posterior approach (PA) in total hip arthroplasty.Methods: This study evaluated postoperative results of 92 consecutive total hip arthroplasties performed by a single surgeon;44 from the DAA,and 48 from PA.The age,body mass index,operation time,blood loss,hospital stay,positioning of the artificial hip,postoperative Harris score and postoperative complications were recorded and analyzed.Results: Both the average age of the patients separately (58.0±11.9) years in DAA group and (61.0±10.4) years in PA group and the body mass index (25.1±3.7) in DAA group and (24.7±3.3) in PA group,showed no significant difference between the two groups.The DAA group had significantly reduced the hospital stay (3.8±1.7) days vs.(4.9±2.3) days for the PA group (P<0.05) and operation time was (76.0±17.4) min in DAA group,and (71.0±14.3) min in PA group (P>0.05).The amount of blood loss: in group DAA (238.0±55.3) mL,and in group PA (387.0±61.2) mL (P<0.05).There was no statistical difference in the positioning of the artificial hip: the cup anteversion in DAA group and PA group was 17.3°±5.3° vs.18.6°±5.1°,the cup inclination was 38.5°±5.7° vs.37.7°±5.2°.In DAA group,there was significantly less use of assistive devices [(24.6±7.8) d vs.(31.7±10.2) d,P<0.05],and the pain was significantly lower.Harris score at the end of 6 weeks of the follow-up: in DAA group 85.7±5.4,and in PA group 81.3±6.1 (P<0.05);at the end of the last follow-up: in DAA group 93.4±4.7,and in PA group 92.3±5.3 (P>0.05).Complications were encountered in the two groups.There were two intraoperative complications (4.4％),1 great trochanter fracture and 1 lateral cutaneous nerve injury in DAA group.No dislocation was observed in DAA group.One dislocations and 1 groin pain were recorded in PA group.No prosthesis loosening,deep vein thrombosis,sciatic nerve injury and other complications occurred in the two groups.Conclusion: Total hip arthroplasty using the anterior approach allows for superior recovery and better stability.