中国修复重建外科杂志

中国修复重建外科杂志

直接前入路与后入路对人工全髋关节置换术后早期康复的影响比较

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目的 比较直接前入路(direct anterior approach,DAA)及后入路(posterior approach,PA)对人工全髋关节置换术后早期康复的影响。 方法 回顾分析 2014 年 3 月—2017 年 5 月,行 PA 或 DAA 人工全髋关节置换术的 83 例股骨头缺血性坏死患者临床资料。其中 48 例采用 PA(PA 组),35 例采用 DAA(DAA 组)。两组患者性别、年龄、体质量指数、股骨头缺血性坏死分期、病程等一般资料比较,差异均无统计学意义(P>0.05)。比较两组患者切口长度、手术时间、总显性失血量、术后首次部分负重及完全负重行走时间、髋关节 Harris 评分和疼痛视觉模拟评分(VAS)。 结果 术后两组切口均 Ⅰ 期愈合,无感染、脱位、假体周围骨折等并发症发生。患者均获随访,随访时间 6~44 个月,平均 30.2 个月。DAA 组 2 例出现股外侧皮神经支配区麻木症状,经对症处理后症状消失。DAA 组手术时间较 PA 组明显延长(P<0.05),但切口长度、总显性失血量、术后首次部分负重行走时间及首次完全负重行走时间均优于 PA 组(P<0.05)。两组术前 Harris 评分比较差异无统计学意义(P>0.05);术后 2 周及 1 个月,DAA 组 Harris 评分明显高于 PA 组(P<0.05),但 3、6 个月时两组间比较差异无统计学意义(P>0.05)。两组患者术前 VAS 评分比较,差异无统计学意义(P>0.05);DAA 组术后 1 d、4 d、1 周及 2 周时 VAS 评分明显低于 PA 组(P<0.05)。 结论 选择 DAA 行人工全髋关节置换术,有利于患者术后快速康复。但该手术入路具有学习曲线较长、适应证较窄、需要特殊手术器械等不足,需慎重选择。

Objective To compare the early rehabilitation effects of total hip arthroplasty (THA) with direct anterior approach (DAA) versus posterior approach (PA). Methods A retrospective analysis was made in the data of 83 patients with unilateral osteonecrosis of the femoral head between March 2014 and May 2017. Forty-eight patients were treated with THA via PA (PA group) and 35 patients were treated with THA via DAA (DAA group). There was no significant difference in gender, age, body mass index, stage of osteonecrosis of the femoral head, and disease duration between 2 groups (P>0.05). The length of incision, operation time, total amount of bleeding, the time of first postoperative walking with crutch, the time of first postoperative walking without crutch, the Harris scores, and the visual analogue scale (VAS) scores of 2 group were recorded and compared. Results All incisions healed primarily and no infection, dislocation, or fracture occurred. All patients were followed up 30.2 months on average (range, 6-44 months). The numbness symptom caused by the lateral femoral cutaneous nerve injury occurred in 2 patients of DAA group and released after symptomatic treatment. The length of incision, total amount of bleeding, the time of first postoperative walking with crutch, and the time of first postoperative walking without crutch of DAA group were significantly superior to those of PA group (P<0.05). The Harris scores of DAA group were significantly higher than those of PA group at 2 weeks and 1 month after operation (P<0.05), while no significant difference was found between 2 groups before operation and at 3 months and 6 months after operation (P>0.05). The VAS scores of DAA group were significantly lower than those of PA group at 1 day, 4 days, 1 week, and 2 weeks after operation (P<0.05), while no significant difference was found between 2 groups before operation (P>0.05). Conclusion DAA is meaningful to enhanced recovery after THA. But it should be chosen carefully because of the disadvantages, such as long learning curve, limited indications, and requirements of specific instruments.

关键词: 人工全髋关节置换术; 直接前入路; 后入路; 早期康复

Key words: Total hip arthroplasty; direct anterior approach; posterior approach; early rehabilitation

引用本文: 张子琦, 王春生, 杨佩, 党晓谦, 王坤正. 直接前入路与后入路对人工全髋关节置换术后早期康复的影响比较. 中国修复重建外科杂志, 2018, 32(3): 329-333. doi: 10.7507/1002-1892.201712059 复制

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