[1]严伟 贺金晓* 潘守峰 谢迎.侧卧位下髋关节直接前入路全髋关节置换术后短期疗效观察[J].中国微创外科杂志,2020,01(4):335-340.
　Yan Wei,He Jinxiao,Pan Shoufeng,et al.Shortterm Clinical Efficacy of Total Hip Replacement by Direct Anterior Approach Under Lateral Decubitus Position[J].Chinese Journal of Minimally Invasive Surgery,2020,01(4):335-340.
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侧卧位下髋关节直接前入路全髋关节置换术后短期疗效观察()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年4期
页码:
335-340
栏目:
临床研究
出版日期:
2020-04-25

文章信息/Info

Title:
Shortterm Clinical Efficacy of Total Hip Replacement by Direct Anterior Approach Under Lateral Decubitus Position
作者:
严伟 贺金晓* 潘守峰 谢迎
(安徽省滁州市第一人民医院骨二科关节外科，滁州239000）
Author(s):
Yan Wei;  He Jinxiao;  Pan Shoufeng;  et al.
Second Department of Orthopedics, First People’s Hospital of Chuzhou, Chuzhou 239000, China
关键词:
侧卧位; 直接前入路; 全髋关节置换术
Keywords:
Lateral decubitus position; Direct anterior approach; Total hip replacement
文献标志码:
A
摘要:
目的探讨侧卧位下髋关节前方直接经肌间隙入路全髋关节置换术的短期疗效。 方法2016年3月～2018年10月，共216例因髋关节疾病入住我科初次行单侧全髋关节置换术，根据病例选择及排除标准，纳入183例，其中髋关节直接前入路（direct anterior approach, DAA）92例（DAA组），髋关节后外侧入路（posterolateral approach, PLA）91例（PLA组），比较2组手术时间、术中出血量、手术切口长度、术后住院时间、手术并发症，临床疗效通过Harris髋关节功能评分（Harris Hip Score,HHS）、疼痛视觉模拟评分（Visual Analogue Score, VAS）评估，通过髋关节正位片对术后假体的位置进行评价。结果DAA组和PLA组手术时间分别为（101.0±15.6）、（98.6±11.6）min，2组间无统计学差异（t=1.198，P=0233）；手术切口长度分别为（122±21）、（126±21）cm，差异无显著性（t=-1441，P=0151）。DAA组术中出血量（2185±201）ml，明显少于PLA组（2500±167）ml（t=-11516，P=0000）；术后住院时间（102±31）d，明显短于PLA组（138±26）d（t=-8629，P=0000）；术后输血率33%(3/92)，显著低于PLA组121%(11/91)（χ2=3873，P=0049）；并发症发生率明显低于PLA组［84%(8/92) vs18.7%(17/91)， χ2=19309，P=0002］。DAA组切口周围感染发生率明显低于PLA组［21%(2/92) vs 99%(9/91)， χ2=4821，P=0028］；术后关节脱位发生率0%（0/92），显著低于PLA组55%（5/91）(Fisher精确检验，P=0029)；2组股外侧皮神经损伤发生率分别为43%（4/92）、0%，差异无显著性（Fisher精确检验，P=0121）。 PLA组1例出现假体周围感染，经足量抗生素治疗无效后，给予翻修手术。随访6～21个月，平均136月。HHS评分术后1、3、6个月和末次随访与术前比较差异均有显著性（P<0.05）。疼痛VAS评分术后3、6个月和末次随访与术前比较差异有显著性（P<005）。术后X线评估2组患者术后假体的位置均处于安全范围内，差异无统计学意义（外展角：427°±33° vs 420°±38°，t=1391，P=0166;前倾角：195°±13° vs 194°±21°，t=0129，P=0897）。结论侧卧位下DAA全髋关节置换术的早期临床疗效良好，具有创伤小、出血少、住院时间短等优点，是一种安全有效的微创手术入路。
Abstract:
ObjectiveTo assess the shortterm clinical results of total hip replacement by direct anterior approach(DAA) under lateral decubitus position.MethodsFrom March 2016 to October 2018, there were 216 patients admitted to our department because of hip diseases and received total hip replacement. According to the criteria of case selection and exclusion, 183 cases were included, including 92 cases of DAA (DAA group) and 91 cases of posterolateral approach (PLA group). The operation time, blood loss, length of incision, postoperative hospital stay, and complications were analyzed. The Harris Hip Score (HHS) and Visual Analogue Score (VAS) were recorded to evaluate efficacy. The position of the prosthesis was evaluated by anteroposterior hip Xray radiography.ResultsThe operation time in the DAA group and PLA group were (101.0±15.6) min and (98.6±11.6) min, respectively, with no significant difference between the two groups (t=1.198,P=0.233). The length of incisions was (12.2±2.1) cm and (12.6±2.1) cm, respectively, with no significant difference between the two groups (t=-1.441,P=0.151). The intraoperative total blood loss in the DAA group was significantly less than that in the PLA group ［(218.5±20.1) ml vs. (250.0±16.7) ml, t=-11.516, P=0.000］. The postoperative hospital stay in the DAA group was shorter than that in the PLA group ［(10.2±3.1) d vs. (13.8±2.6) d, t=-8.629, P=0000］. There were 3 of 92 cases (3.3%) in the DAA group and 11 of 91 cases (12.1%) in the PLA group who received blood transfusion and there was significant difference between the two groups (χ2=3873, P=0.049). In terms of complications, the total complications incidence in the DAA group was lower than that in the PLA group ［8.4% (8/92) vs. 18.7% (17/91), χ2=19.309, P=0.002］. The incidence of superficial surgical site infection in the DAA group were much lower than that in the PLA group［2.1% (2/92) vs. 9.9% (9/91), χ2=4.821, P=0.028］. There was significant difference between the two groups in joint dislocation ［0% (0/92) vs. 5.5% (5/91), Fisher’s exact test, P=0.029］. The incidence of lateral femoral cutaneous nerve injury in the DAA group was higher than that in the PLA group, however, the difference was not significant ［4.3%(4/92) vs. 0%,Fisher’s exact test, P=0.121］. There was one patient in the PLA group diagnosed with periprosthetic infection. The patient failed in conservative treatment with sufficient antibiotics and then received revision surgery. Compared with preoperation, there were significant differences in HHS at 1, 3, and 6 month postoperatively and at the last followup in both groups (P<0.05). Compared with preoperation, there were significant differences in VAS at 3 and 6 month postoperatively and at the last followup in both groups (P<0.05). Cup inclination and anteversion angle in both groups were all located in the safe range without significant difference (inclination angle: 42.7°±3.3° vs. 420°±3.8°, t=1.391, P=0.166; anteversion angle: 19.5°±1.3° vs. 19.4°±2.1°, t=0.129, P=0.897).ConclusionWith the advantages of less invasion, less blood loss and shorter hospital stay, total hip replacement by DAA under lateral decubitus position is a safe and effective minimally invasive surgical method.

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备注/Memo

备注/Memo:
*通讯作者，Email：1124931493@qq.com
更新日期/Last Update: 2020-07-14