前外侧入路与后外侧入路行全髋关节置换术的比较研究

目的比较前外侧入路(ASA)与后外侧入路(PSA)行全髋关节置换术的临床疗效。方法收集该院2000年2月至2008年4月经PSA行全髋关节置换术85例92髋,男47例51髋,女38例41髋;年龄55～85岁,平均年龄72.5岁;体质量指数(BMI)18.2～25.1kg/m2,平均21.1kg/m2。股骨头缺血坏死35髋,骨关节炎5髋,老年股骨颈移位骨折52髋,骨水泥固定48髋,生物型固定44髋。术前Harris评分平均31.5分。同期采用常规ASA行全髋关节置换术70例76髋,男39例42髋,女31例34髋;年龄53～88岁,平均71.9岁;BMI 19.5～26.2kg/m2,平均20.5kg/m2。股骨头缺血坏死29髋,骨关节炎4髋,老年股骨颈移位骨折43髋,骨水泥固定40髋,生物型固定36髋,术前Harris评分平均31.3分。有1例因为过于肥胖,由原计划的ASA改为PSA,该病例没有被纳入研究。对两组病例的手术时间、出血量、切口长度、术后住院时间、髋臼假体角、手术关节的脱位率进行比较。结果术后随访16～36个月,平均23.4个月,所有病例均无神经损伤并发症,ASA组出现1例感染,手术2年后行翻修手术,PSA组有2例死亡,PSA组有1例尿管连接处脱开,污染了切口。两组术中出血量比较,差异无统计学意义。切口长度PSA组为17.0cm,ASA组为13.0cm。手术时间PSA组平均为80min,ASA组平均为65min。住院时间PSA组为18.5d,ASA组为13.2d。术后影像学中髋臼假体角,PSA组的前倾角为22°,ASA组的前倾角为10°。PSA组有4例出现1～2次脱位,ASA组无脱位发生。两组切口长度、手术时间、住院时间、髋臼假体前倾角、手术后关节脱位率比较,差异有统计学意义。结论除部分肥胖患者外,选择ASA行全髋关节置换术,能在相对较短的切口下和相对较少的手术时间内完成手术,达到缩短住院时间和减少手术后假体脱位发生的目的。

Comparison of anterolateral approach and posterolateral approach in the total hip arthroplasty

Objective To compare the clinical effects of anterolateral and posterolateral surgical approaches in total hip arthroplasty(THA).Methods 85 cases of 92 THA were treated by posterolateral surgical approach(PSA group).Among them,there were 47 males and 38 females.The mean age was 72.5 years,the mean BMI was 21.1 kg/m2,and the mean Harris score was 31.5.Another 70 cases of 76 THA were treated by anterolateral surgical approach(ASA group) at the same period.Among them,there were 39 males and 31 females.The mean age was 71.9 years,the mean BMI was 20.5 kg/m2,and the mean Harris score was 31.3.The mean age,BMI and Harris score were similar between the ASA and PSA groups.Operation time,blood loss,incision length,postoperative hospitalization,prosthetic position and dislocation rate were analysed and compared between above-specified two groups.Results Follow-up investigation for these patients was conducted for average 23.4 months,of which 1 case in ASA group was infected,and 2 cases in PSA group died.There were no significant differences of blood loss in these two groups.The average incision length was 17.0 cm in PSA group and 13.0 cm in ASA group.The average operation time was 80 minutes in PSA group and 65 minutes in ASA group.The average postoperative hospitalization was 18.5 days in PSA group and 13.2 days in ASA group.According to imaging of postoperative acetabular prosthesis angle,PSA group anteversion was 22°,and ASA group anteversion was 10°.While the surgery,dislocation of 4 cases occurred once or twice in PSA,and no dislocation occurred in ASA group.There was significant difference of operation time,incision length,postoperative hospitalization and prosthetic position between the two groups.Conclusion Apart from some obese patients,using anterolateral approach for total hip arthroplasty can complete the surgery in a relatively short operation time and under a relatively small incision,thus shortening the hospitalization time and reducing post operative dislocations.