[1]陶涛 郭炯炯* 徐南伟.微创直接前入路与后外侧入路全髋关节置换术早期疗效的比较[J].中国微创外科杂志,2020,01(5):431-435.
　Tao Tao,Guo Jiongjiong,Xu Nanwei..Comparison of Early Effects of Total Hip Replacement Between Direct Anterior Approach and Posterior Lateral Approach[J].Chinese Journal of Minimally Invasive Surgery,2020,01(5):431-435.
点击复制

微创直接前入路与后外侧入路全髋关节置换术早期疗效的比较()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年5期
页码:
431-435
栏目:
临床研究
出版日期:
2020-05-31

文章信息/Info

Title:
Comparison of Early Effects of Total Hip Replacement Between Direct Anterior Approach and Posterior Lateral Approach
作者:
陶涛 郭炯炯* 徐南伟
（南京医科大学附属常州第二人民医院关节外科，常州213000）
Author(s):
Tao Tao;  Guo Jiongjiong;  Xu Nanwei.
Department of Orthopedics, Affiliated Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou 213000, China
关键词:
股骨颈骨折; 髋关节置换术; 直接前入路
Keywords:
Femoral neck fracture; Hip replacement; Direct anterior approach
文献标志码:
A
摘要:
目的探讨微创直接前入路(direct anterior approach，DAA)全髋关节置换术治疗老年股骨颈骨折的价值。方法回顾性比较2016年9月~2017年12月微创DAA人工全髋关节置换术（DAA组）与后外侧入路同时重建外旋肌群（对照组）治疗股骨颈骨折的疗效，观察指标包括手术时间、手术切口长度、术中出血量、术后引流量、下地时间、髋臼外展角、柄假体颈干角、髋臼前倾角、髋臼假体直径、术后72 h疼痛视觉模拟评分（Visual Analogue Score,VAS）以及术后1、6个月Harris髋关节评分(Harris Hip Score,HSS)。结果DDA组手术切口长度（9.5±1.2）mm，明显短于对照组（15.1±1.1）mm（t=-21.920，P=0.00）；术后引流量（263.7±115.1）ml，明显少于对照组（428.0±165.8）ml（t=-4.996，P=0.00）；术后下地时间（1.9±0.9）d，明显短于对照组（4.6±06）d（t=-16.769，P=0.00）；术后72 h内VAS评分（2.3±0.5）分，明显小于对照组评分（2.6±0.5）分（t=-2.552，P=0013）；术后1个月HHS评分（75.7±5.9）分，明显高于对照组（70.2±7.1）分（t=3703，P=0.000）；术后6个月2组HHS评分分别为（94.4±2.1）、（93.4±2.3）分，差异无统计学意义（t=1.947，P=0.055）。DAA组1例发生无移位大转子骨折，2个月后恢复，对照组发生1例脱位，并发症发生率分别为2.9％（1/35）、2.2％（1/45），差异无统计学意义（Fisher精确检验，P=1.000）。结论DAA全髋关节置换术治疗股骨颈骨折，手术切口较小，术后疼痛轻，术后首次下地时间早，早期髋关节功能好，早期的临床疗效好。
Abstract:
ObjectiveTo investigate the value of minimally invasive direct anterior approach (DAA) total hip replacement for femoral neck fracture in elderly patients. MethodsFrom September 2016 to December 2017, minimally invasive DAA total hip replacement (DAA group) and posterior lateral approach operation with reconstruction of the external rotation muscle group (control group) for the treatment of femoral neck fracture were retrospectively compared. The observation parameters included operation time, incision length, intraoperative bleeding volume, postoperative drainage, outofbed time, acetabulum abduction angle, femoral stem prosthesis angle, acetabulum anteversion angle, diameter of acetabulum prosthesis, the pain Visual Analogue Score (VAS) at 72 hours after operation, and Harris Hip Score (HHS) at 1 and 6 months postoperatively.ResultsThe incision length of DAA group was (9.5±1.2) mm, which was significantly shorter than that of the control group ［(15.1±1.1) mm, t=-21.920, P=0.000］. The postoperative drainage volume was (263.7±115.1) ml, which was significantly less than that of the control group ［(428.0±165.8) ml, t=-4.996, P=0.000］. The postoperative outofbed time was (1.9±0.9) d, which was significantly shorter than that of the control group ［(4.6±0.6) d, t=-16.769, P=0.000］. The VAS score at 72 hours after operation of DAA group (2.3±05) points was significantly lower than that of the control group ［(2.6±0.5) points, t=-2.552, P=0.013］. The HHS score (75.7±5.9) points was significantly higher than that of the control group ［(70.2±7.1) points, t=3.703, P=0.000］. There was no significant difference in the HHS score between the two groups at 6 months after operation ［(94.4±2.1) points vs. (93.4±2.3) points, t=1.947, P=0.055］. One case in the DAA group had greater trochanter fracture without displacement and recovered 2 months later. One case in the control group had dislocation. The incidence of complications was 2.9%(1/35) and 2.2%(1/45), respectively. The difference was not statistically significant (Fisher’s exact test, P=1.000).ConclusionDAA total hip replacement has advantages of short length of incision, less postoperative pain, early postoperative walk, and early recovery of postoperative hip function.

参考文献/References:

[1]施俊峰,王晓东,万宏来, 等. SuperPATH与直接前方入路微创全髋关节置换学习阶段的结果比较.中国微创外科杂志,2019,19(5):435-438,454.
[2]魏滨,张华,徐懋,等.髋部骨折老年患者发生严重术后谵妄的多因素分析.中国微创外科杂志,2017,17(1):38-41.
[3]邓昶.SuperPATH入路微创全髋关节置换术的研究进展.中国微创外科杂志,2018,18(2):169-172.
[4]Zhang X, Shi G, Sun X, et al. Factors influencing the outcomes of artificial hip replacements. Cells Tissues Organs,2018,206(4-5):254-262.
[5]Lindgren JV, Wretenberg P, Krrholm J, et al. Patientreported outcome is influenced by surgical approach in total hip replacement: a study of the Swedish Hip Arthroplasty Register including 42,233 patients. Bone Joint J,2014,96-B(5):590-596.
[6]Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An endresult study using a new method of result evaluation. J Bone Joint Surg Am，1969，51(4):737-755.
[7]De Roeck N. A prospective randomised trial of internal fixation versue arthroplasty for displace fractures of neck of the femur.J Bone Joint Surg Br,2003,85(3):464-465.
[8]White RE Jr, Forness TJ, Allman J,et al. Effect of posterior capsular repair on early dislocation in primany total hip replacement. Clin Orthop Relat Res,2001,(393):163-167.
[9]于野,赵振洪.全髋关节置换与人工股骨头置换治疗股骨颈骨折的近期疗效.临床骨科杂志,2018,21(1):47-49.
[10]Tsukada S, Wakui M. Lower dislocation rate following total hip arthroplasty via direct anterior approach than via posterior approach: fiveyearaverage followup results. Open Orthop J,2015,9:157-162.
[11]Parcells BW, Mackent DM, Kayiaros ST. The direct anterior approach for Ⅰstage bilateral total hip arthroplasty:early outcome analysis of a singlesurgeon case series. J Arthroplasty,2016,31(2):434-437.
[12]De Geest T, Fennema P, Lenaerts C, et al. Adverse effects associated with the direct anterior approach for total hip arthroplasty: Bayesian metaanalysis. Arch Orthop Trauma Surg,2015,135(8):1183-1192.
[13]王政,陈佳,高博,等.微创直接前入路在全髋关节置换术中的临床应用.临床合理用药,2017,10(5A):180-181.
[14]Bergin PF, Doppelt JD, Kephart CJ, et al. Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers. J Bone Joint Surg Am,2011,93(15):e89.
[15]Moskal JT. Anterior approach in THA improves outcomes: affirms. Orthopedics，2011,34(9):e456-e458.
[16]Kong X, Grau L, Ong A, et al. Adopting the direct anterior approach: experience and learning curve in a Chinese patient population. J Orthop Surg Res,2019,14(1):218.

备注/Memo

备注/Memo:
*通讯作者，Email: drjjguo@163.com
更新日期/Last Update: 2020-08-08