直接前方入路全髋关节置换术治疗高脱位型髋关节发育不良的临床应用

目的 探讨直接前方入路 (DAA ) 全髋关节置换术 (THA ) 治疗高脱位型髋关节发育不良 (DDH ) 的临床疗效和安全性。方法 回顾性分析2016 年 6 月— 2019 年 10 月蚌埠医学院第一附属医院8例采用DAA入路行 THA 治疗的DDH 患者的临床资料。其中男1例、女7例,年龄(61.86±8.49)岁,Crowe Ⅲ型 7例7髋、Crowe Ⅳ 型1例1髋。观察患者手术切口长度、手术时间、术中出血量、术后下床时间、住院时间,以及手术并发症情况;术后1周测量患者髋臼杯外展角及前倾角;对比观察术前、术后1周及末次随访时患者双下肢长度差异、髋关节 Harris评分以及中心边缘(CE)角的变化。结果 手术切口长度为(7.56±0.62)cm,手术时间为(108±17.65) min,术中出血量为(205±47.20) mL,术后下床时间为(3.25±0.88)d,住院时间为(5.50±0.76)d。术后1周髋臼杯外展角和前倾角测量值分别为41.40°±4.03°和17.90°±3.27°,均处于安全范围。术前、术后1周和末次随访时,患者双下肢长度差值、Harris 评分和CE角测量值分别为(3.98±0.47)cm、(43.38±9.65) 分、15.86 °± 2.20°,(0.85±0.25)cm、(80.63±4.37)分、37.29°± 2.21°,(0.81±0.20)cm、(80.50±4.75)分、37.17°± 2.07°:术前、术后1周、末次随访时3组数据比较差异均有统计学意义(F=597.814、40.866、150.145, P值均＜0.01),术后1周与末次随访时比较差异均无统计学意义(P值均＞0.05)。1例术后出现股外侧皮神经损伤症状,未见术中股骨骨折、髋脱位、坐骨神经损伤、下肢深静脉血栓形成等并发症。结论 采用DAA入路治疗高脱位型DDH患者,手术安全,可以取得良好的临床疗效。

Clinical application of direct anterior approach for total hip arthroplasty as a treatment of high dislocation type hip dysplasia

Objective This study aims to explore the clinical efficacy of total hip arthroplasty (THA) via direct anterior approach (DAA) for the treatment of high dislocation type developmental dysplasia hip (DDH). Methods A retrospective analysis was conducted on the clinical data of eight patients (one male and seven females aged [61.86±8.49] years, seven Crowe Ⅲ cases, seven hips and one Crowe Ⅳ, one hip) with Crowe Ⅲ-Ⅳ DDH who underwent THA through DAA approach in the First Affiliated Hospital of Bengbu Medical College from June 2016 to October 2019. The length of incision, operation time, intraoperative bleeding volume, stay earlier out-of-bed activity, length of hospital stay, and surgical complications were observed. The abduction angle and antegrade hip angle of acetabular cup were measured at 1 week after operation. Differences in the length of lower limbs, Harris score, and center-edge(CE) angle of hip joint were compared before operation, 1 week after operation, and the last follow-up. Results The length of incision, operative time, intraoperative bleeding volume, stay earlier out-of-bed activity, and length of hospital stay were (7.56±0.62)cm, (108±17.65) min, (205±47.20) mL, (3.25±0.88)d, and (5.50±0.76)d, respectively. The acetabular cup abduction angle and anteversion angle at 1 week after operation were 41.40°± 4.03° and 17.90°±3.27° respectively, which were in the Lewinnek safe range. The length difference, Harris score, and CE angle were (3.98±0.47) cm, (43.38±9.65) points, and 15.86°±2.20°, respectively, before operation, and (0.85±0.25) cm, (80.63±4.37) points, and 37.29°±2.21°, respectively, 1 week after operation and (0.81±0.20) cm, (80.50±4.75) points, and 37.17°±2.07°, respectivly, the last follow-up (F=597.814、40.866、150.145, all P values＜0.01). No significant difference in the length difference, Harris score, and CE angle was found between the two lower limbs at 1 week after operation and at the last follow-up (all P values＞0.05). In this group, one case of lateral femoral cutaneous nerve injury symptom was noted. No femoral fracture, hip dislocation, sciatic nerve injury, lower limb deep venous thrombosis, and other severe complications were reported. Conclusions The DAA approach is safe and can achieve good clinical effect for the treatment of patients with high dislocation type hip dysplasia.