改良微创直接前侧入路全髋关节置换术的疗效观察

目的探讨改良微创直接前侧入路(LDAA)全髋关节置换术的临床疗效及其可靠性、安全性。方法回顾性对照研究。选取2015年1月—2018年1月中国科学技术大学附属第一医院骨科行LDAA和后外侧入路(PLA)全髋关节置换术的患者364例,其中男181例、女183例,年龄46~79(56±11)岁。按手术入路不同分为2组,其中LDAA组184例,PLA组180例。比较两组患者的性别、年龄、BMI、疼痛视觉模拟评分(VAS)、术中出血量、住院时间、48 h出院率、输血例数,以及总并发症发生情况。术后1个月、1年及末次随访时,采用髋关节功能Harris评分评价髋关节功能。术后1个月拍摄标准骨盆正位X线片,对患者臼杯前倾角度、臼杯外展角度、臼杯安全范围例数、股骨柄周边透明带评分、股骨柄中置例数及双下肢长度差异进行X线影像学评估。结果术前两组患者的性别、年龄、BMI、髋关节功能Harris评分、疼痛VAS比较,差异均无统计学意义(P值均>0.05)。LDAA组术中出血量、输血率、住院时间、48 h出院率分别为(250±123)mL、1.09%、(47.5±2.5)h、85.87%,PLA组分别为(370±184)mL、17.78%、(66.5±3.5)h、85.87%。与PLA组比较,LDAA组术中出血量少、输血率低,住院时间短,48 h出院率高,差异均有统计学意义(P值均<0.05);而术中、术后总并发症发生率比较,两组间差异无统计学意义(P>0.05)。364例患者均获得随访,随访时间11~14(12±1.5)个月。术后1个月、1年及末次随访时,组内比较两组患者术后髋关节功能Harris评分均高于术前,差异均有统计学意义(F=6.380、9.170,P值均<0.05);而不同时间点两组间Harris评分比较,差异均无统计学意义(P值均>0.05)。术后1个月骨盆正位X线片影像学评估,两组患者臼杯前倾角度、臼杯外展角度、臼杯安全范围率、股骨柄周边透明带评分、股骨柄中置率及双下肢长度差异长度比较,差异均无统计学意义(P值均>0.05)。结论经LDAA行全髋关节置换术,术式安全,临床疗效可靠,更利于患者快速康复。

Clinical evaluation of modified direct anterior approach for total hip arthroplasty

Objective To analyze the clinical outcomes, feasibility, and reliability of a modified direct anterior approach in lateral decubitus position for total hip arthroplasty (THA).Methods This retrospective cohort study enrolled 364 patients (181 males and 183 females) aged 46-79 (56±11) years, who were randomly selected for primary unilateral THA between January 2015 and January 2018 in the Department of Orthopedics in Anhui Provincial Hospital, the First Affiliated Hospital of the University of Science and Technology of China. The patients were divided into the modified direct anterior approach in lateral decubitus position group (LDAA group, n=184) and the posterolateral approach group (PLA group, n=180). General information gender, age, body mass index(BMI), and visual analog scale (VAS)score) ], blood loss, length of stay, 48-hour discharge rate, transfusion rate, and total complication rate were analyzed. Harris score was used in the clinical outcome evaluation during the 1 month and 1 year follow-up. Radiographic assessment was performed by measuring anteversion, inclination, safe zone of cup, transparent line score, stem position, and lower limb discrepancy on the pelvic X-ray 1 month postoperation.Results Preoperative comparison of general information (gender, age, BMI, and VAS) exhibited no statistical significance (all P values>0.05). The intraoperative blood loss, transfusion rate, length of stay, and 48-hour discharge rate of the LDAA group were (250±123) mL, 1.09%, (47.5±2.5) h, and 85.87%, respectively; and those of the PLA group were (370±184) mL, 17.78%, (66.5±3.5) h, and 6.11%, respectively. The LDAA group exhibited less blood loss, lower transfusion rate, shorter hospital stay, and higher 48-hour discharge rate compared with the PLA group (all P values<0.05). However, the incidence of total complications between the two groups was not statistically different (P>0.05). The follow-up period ranged from 11 months to 14 months (average: 12 months). The Harris score of both groups improved at 1 month and 1 year postoperation (F=6.380 , 9.170, all P values<0.05). The Harris scores between the two groups at different time points were insignificantly different (all P values>0.05). The radiographic assessment of anteversion, inclination, safe zone of cup, transparent line score, stem position, and lower limb discrepancy on the pelvic X-ray 1 month postoperation presented no statistical significance (all P values>0.05).Conclusions The use of modified LDAA in lateral decubitus position for THA is feasible, reliable, and recover faster.