三种手术入路行全髋关节置换术的比较

目的]探究直接前方入路(DAA)、直接外侧入路(DLA)及后外侧入路(PLA)进行全髋关节置换(total hip arthroplasty,THA)的临床效果。方法]选取2015年4月~2019年1月本院骨科收治的146例首次行THA的患者,依据微创入路途径分为DAA组(50例)、DLA组(48例)和PLA组(48例),DAA组采用DAA入路进行全髋关节置换,DLA组采用DLA入路行全髋关节置换,PLA组采用PLA入路进行全髋关节置换。比较三组的临床资料。结果]三组患者均顺利完成手术。三组手术时间、切口长度和术中出血量差异均无统计学意义(P>0.05)。三组间患者的Harris评分均随时间推移显著增加,不同时间点间的差异均有统计学意义(P<0.05),但相同时间点三组间的差异均无统计学意义(P>0.05)。影像测量方面,DAA组髋臼假体外展角大于DLA组和PLA组(P<0.05),而三组前倾角、双下肢长度差别及股骨偏心距差异均无统计学意义(P>0.05)。结论]对于实施全髋关节置换术的患者,DAA入路具有更好的髋臼假体外展角。

Comparison of three surgical approaches for total hip arthroplasty

Objective]To compare the clinical outcomes of total hip arthroplasty(THA)through the direct anterior ap?proach(DAA),direct lateral approach(DLA)and posterolateral approach(PLA).Methods]From April 2015 to January 2019,146 patients who received THA for the first time were divided into DAA group(50 cases),DLA group(48 cases)and PLA group(48 cases).The primary THA was conducted through the DDA,DLA and PLA correspondingly in the 3 groups.The periopera?tive data,Harris scores and radiographic measurements were compared among the 3 groups.Results]All the patients in the 3 groups had operation conducted smoothly.There was no significant difference in operation time,incision length and intraopera?tive blood loss among the 3 groups(P>0.05).The Harris score significantly increased over time in the 3 groups(P<0.05),never?theless no significant difference in Harris score was proved among the 3 groups at any matching time point(P>0.05).Regarding the radiographic assessment,the abduction angle of acetabular component in DAA group was significantly greater than that in the DLA group and the PLA group(P<0.05),whereas there were no significant differences in anteversion angle,discrepancy in length of lower limbs and femoral offset among the 3 groups(P>0.05).Conclusion]Compared with DLA approach and PLA ap?proach,DAA approach is prone to achieve better abduction angle of acetabular component in primary total hip arthroplasty.