人工全髋关节置换术直接前入路与前外侧入路的疗效比较

Comparison of Curative Effect of Direct Anterior Approach and Anterior Lateral Pproach for Total Hip Replacement

摘要: 目的：比较人工全髋关节置换术直接前入路与前外侧入路的临床疗效差异。方法：选取2017年10月至2019年1月在济宁市第一人民医院骨关节科行初次髋关节置换的患者80例，其中，40例采用直接前入路，40例采用前外侧入路。比较两组患者手术切口长度、手术时间、术中出血量、术后引流量、术后卧床动时间，比较术后3周、3个月及6个月髋关节Harris评分。计数资料组间对比进行x2检验；计量资料进行独立样本t检验。结果：直接前入路组手术时间较外侧入路组长，切口长度、术中出血量、术后引流量、术后卧床时间较前外侧入路组减少，差异均有统计学意义(P < 0.01)。直接前入路组患者术后3周的Harris评分高于前外侧入路组，差异有统计学意义(P < 0.01)；术后3个月和6个月Harris评分持续改善，且在不同时间点*组间交互作用有显著性差异，具有统计学意义(P < 0.01)。结论：直接前入路和前外侧入路均为髋关节置换术的典型入路方式，与前外侧入路相比，直接前入路短期综合疗效显著，更有利于术后恢复。

Abstract: Objective: To compare the clinical effect of direct anterior approach and anterolateral approach in total hip arthroplasty. Methods: 80 patients who received total hip arthroplasty from October 2017 to Janurary 2019 in our hospital were divided into two groups according to the surgical approach: direct anterior approach was used in 40 patients and anterolateral approach was used in 40 patients. The incision length, operation time, intraoperative blood loss, postoperative drainage volume and bedridden time were compared between the two groups. Harris scores at 3 weeks, 3 months and 6 months after operation were also compared by chi-square test or independent t test. Results: The operation time of the direct anterior approach group was longer than that of the anterolateral approach group, the length of the incision, the intraoperative blood loss, the postoperative drainage volume and bedridden time were reduced, and the difference was statistically significant (P < 0.01). Harris score of the patients in the direct anterior approach group was higher than that in the anterolateral approach group 3 weeks after operation, and the difference was statistically significant (P < 0.01). 3 months and 6 months after operation, Harris scores continued to improve, and there were significant differences in the interaction between groups at different time points (P < 0.01). Conclusion: The direct anterior approach and the anterolateral approach are typical approaches for hip arthroplasty. Compared with the anterolateral approach, the short-term combined effect of direct anterior approach is significant, which is more beneficial to postoperative recovery.