SuperCap入路和直接前入路全髋关节置换术的早期临床疗效比较

目的:比较SuperCap入路与直接前入路(direct anterior approach,DAA)全髋关节置换(total hip arthroplasty,THA)早期随访的临床疗效。方法:回顾分析2016年1月至2017年6月行微创SuperCap入路和DAA入路THA 70例患者的临床资料,其中SuperCap入路组30例,男15例,女15例,年龄45~71(57.96±15.46)岁;DAA组40例,男24例,女16例,年龄51~76(59.88±13.56)岁。观察比较两组患者术后3 d血红蛋白水平、术后输血率、髋臼外展角、髋臼前倾角、术后肌酸激酶水平,术后3个月和末次随访Harris评分,术后1周和末次随访疼痛视觉模拟评分(visual analogue scale,VAS),并记录末次随访并发症发生情况。结果:两组患者术后均获随访,SuperCap入路组随访时间24~30个月,DAA组随访时间24~36个月。两组患者术后3 d血红蛋白水平、术后输血率、术后1 d髋臼外展角、术后1 d髋臼前倾角比较,差异均无统计学意义(P>0.05)。两组患者术后3个月和末次随访Harris评分比较,差异无统计学意义(P>0.05)。两组患者术后6周和末次随访VAS比较,差异无统计学意义(P>0.05)。SuperCap入路组术后3 d肌酸激酶水平明显低于直接前入路组(P<0.05)。结论:SuperCap入路全髋关节置换术后临床效果可以媲美DAA入路,且软组织损伤更小,能够实现术后快速康复,同时学习曲线短,是一种安全、有效的手术入路。

Comparison of early clinical outcomes between SuperCap and direct anterior approaches for total hip arthroplasty

Objective To compare the short-term clinical efficacy of SuperCap approach and direct anterior approach in total hip arthroplasty. Methods Clinical data of 70 patients who underwent minimally invasive SuperCap approach and DAA THA in January 2016 to June 2017 were retrospective analyzed. These patients were divided into two groups:SuperCap approach group(SuperCap group) and direct anterior approach group(DAA group). There were 15 males and 15 females in SuperCap group,aged from 45 to 71 years old,and the follow-up time ranged from 24 to 30 months. There were 24 males and 16 females in Group B,aged from 51 to 76 years and the follow-up time ranged from 24 to 36 months. Hemoglobin level of the 3rd day after operation,transfusion rate,acetabular abduction angle,anteversion angle and creatine kinase level of the 3rd day after operation,Harris score of 3 months and the last time,VAS score of 1 week and the last time were recorded and compared. Complications were recorded at the final follow-up. Results All patients were followed up,the follow-up time of SuperCap group ranged from 24 to 30 months,that of DAA group ranged from 24 to 36 months. No significant differences were found in hemoglobin level on the 3rd day after operation,transfusion rate,Harris score or VAS score between two group (P>0.05). There was no significant difference in Harris score between 3 months after operation and the final follow-up in both groups (P>0.05). There were no significant difference in VAS scores of 6 weeks after operation and on the final follow-up neither(P>0.05). The level of creatine kinase in SuperCap group was significant lower than that in DAA group(P<0.05). Until the final follow-up,there was no significant difference in the incidence of complications between the two groups(P>0.05). Conclusion The clinical effect of minimally invasive SuperCap approach after total hip arthroplasty is comparable to that of DAA approach with less soft tissue injury. Patients can recover rapidly after operation and it is a safe and effective surgical approach for surgeons with short learning curve.