微创直接前入路和传统后外侧入路全髋关节置换短期临床结果对比

Comparison of Short-Term Clinical Results of Minimally Invasive Direct Anterior Approach and Traditional Posterolateral Approach for Total Hip Arthroplasty

摘要: 目的：对人工假体全髋关节置换(Total hip arthroplasty, THA)的微创直接前入路(Direct anterior approach, DAA)和传统后外侧入路(Posterolateral approach, PLA)两种不同手术入路的患者进行短期临床结果对比。方法：选择我院2019年10月~2022年5月期间收治的100例行单侧初次全髋关节置换术的患者，根据微创DAA和传统PLA手术入路分为两组，观察组(50例)和对照组(50例)，观察组患者采用DAA行全髋关节置换手术，对照组则应用PLA行全髋关节置换术。分下面三个方面进行对比。1) 对两组手术患者的手术切口长度、术中失血量、手术时间、住院时间指标对比；2) 对术前髋关节功能Harris评分、术后1个月髋关节功能Harris评分和术后髋臼前倾角、外展角对比；3) 对术后并发症进行统计对比。结果：1) 观察组(DAA)患者手术期间切口长度、术中出血量、手术时间都比对照组(PLA)数值小；住院时间因符合要求后术后出院时间基本相同，无特殊临床指导意义。2) 微创DAA组和传统PLA组术前髋关节功能Harris评分比较无统计学意义(P > 0.05)。术后1个月髋关节功能Harris评分，观察组略高于对照组，有统计学意义(P < 0.05)。3) 术后并发症的统计。DAA组9例发生术后并发症，股外侧皮神经损伤6例，股骨大转子骨折1例，切口感染2例。对照组(PLA)发生4例并发症，1例深静脉血栓，1例切口感染，2例髋关节后脱位。结论：针对全髋关节置换术患者，微创DAA能够减少出血、减轻创伤，尽早恢复髋关节功能，所以符合DAA入路条件的，应用直接前(DAA)入路比后外侧入路(PLA)效果更好，可供临床医师选择。

Abstract: Objective: The short-term clinical results of minimally invasive direct anterior approach (Direct anterior approach, DAA) and traditional posterolateral approach (Posterolateral approach, PLA) for total hip arthroplasty (Total hip arthroplasty, THA) were compared. Methods: A total of 100 pa-tients who underwent unilateral primary total hip arthroplasty in our hospital from October 2019 to May 2022 were divided into two groups according to minimally invasive DAA and traditional PLA approach: observation group (n = 50) and control group (n = 50). The patients in the observation group were treated with DAA and the control group were treated with PLA. It is divided into the following three aspects for comparison. 1) Comparison of incision length, intraoperative blood loss, operation time and hospitalization time between the two groups; 2) There was no statistical signifi-cance in preoperative Harris score of hip function between minimally invasive DAA group and tra-ditional PLA group (P > 0.05). One month after surgery, the Harris score of hip function in the ob-servation group was slightly higher than that in the control group, with statistical significance (P < 0.05); 3) Statistical comparison of postoperative complications. Results: 1) The incision length, in-traoperative blood loss and operation time of the patients in the observation group (DAA) were smaller than those in the control group (PLA), and the hospitalization time was basically the same after operation, which had no special clinical significance. 2) There was no significant difference in preoperative hip function Harris score between minimally invasive DAA group and traditional PLA group (P > 0.05). 3) Statistics of postoperative complications. Postoperative complications occurred in 9 cases in DAA group, including 6 cases of lateral femoral cutaneous nerve injury, 1 case of great-er trochanter fracture and 2 cases of incision infection. In the control group (PLA), there were 4 complications, including 1 case of deep venous thrombosis, 1 case of incision infection and 2 cases of posterior dislocation of hip joint. Conclusion: For patients undergoing total hip arthroplasty, mini-mally invasive DAA can reduce bleeding, reduce trauma and restore hip function as soon as possible, so for those who meet the conditions of DAA approach, the effect of direct anterior (DAA) approach is better than posterolateral approach (PLA), which can be selected by clinicians.