【摘要】 [目的]比较侧卧位直接前入路(DAA)与后外侧入路(PLA)全髋关节置换术(THA)的早期临床效果。[方法]共纳入拟行单侧THA患者127例,采用随机数字表法将患者分为两组。65例采用DAA入路行THA,其余62例采用PLA入路行THA。比较两组患者的围手术期、随访和影像资料。[结果]两组患者术中均未发生严重并发症,除DAA组有1例患者发生术中股骨近端劈裂骨折,术中给予钢丝捆扎。DAA组切口长度、术后第1 d血红蛋白下降水平和术后首次下地时间显著优于PLA组(P<0.05),但两组在手术时间、术中出血量、住院时间方面差异均无统计学意义(P>0.05)。术前两组间VAS评分差异无统计学意义(P>0.05);术后DDA组的VAS评分均小于PLA组,术后24 h和36 h时两组间差异有统计学意义(P<0.05),术后72 h时两组差异已无统计学意义(P>0.05)。127例患者随访12个月以上,随时间推移,两组患者的Harris评分均显著增加,而WOMAC评分均显著减少(P<0.05)。术后各时间点DAA组的Harris评分均高于PLA组,其中术后1个月和3个月时两组间差异有统计学意义(P<0.05),而术后6个月和12个月时两组间差异无统计学意义(P>0.05)。术后各时间点DAA组的WOMAC评分均显著低于PLA组,各时间点两组间差异均有统计学意义(P<0.05)。至末次随访时,未见假体松动、移位或断裂。两组患者的髋臼假体外翻角、前倾角和股骨偏心距未见显著差异(P>0.05)。[结论]与后外侧入路比较,直接前入路具有切口短、术后失血量少、术后疼痛轻等优势,其术后早期髋关节功能恢复更好。更多还原

【Abstract】 [Objective] To compare the early clinical outcomes of direct anterior approach(DAA) and posterolateral approaches(PLA) for primary unilateral total hip arthroplasty(THA). [Methods] A total of 127 patients who were undergoing primary unilateral THA were included into this prospective randomized controlled study, and were divided into 2 groups by the random table method. In term of approach applied, 65 patients had THA performed through DAA, while the remaining 62 patients received THA through PLA. The perioperative, follow-up and radiographic data were compared between the two groups. [Results] No serious complications happened in anyone of the patients during operation, except splitting fracture of the proximal femur in 1 patient of the DDA group, which was fixed by cerclage wire. The DAA group proved significantly superior to the PLA group regarding to incision length, decline of hemoglobin at the first day after operation and the time to return ambulation(P<0.05), nevertheless no statistically significant differences were noted in operation time, intraoperative blood loss and hospital stay between the two groups(P>0.05). Regardless of no a significant difference in VAS score before operation between them(P>0.05), the DAA group had less VAS scores than the PLA group postoperatively, which was statistically significant at 24 hours and 36 hours(P<0.05), whereas became not significant at 72 hours(P>0.05). As time went during the follow-up period more than 12 months, the Harris score significantly increased, while the WOMAC score significantly decreased in both groups(P<0.05). The DAA group was marked higher Harris score than the PLA group postoperatively, which proved statistically significant at 1 month and 3 months(P<0.05), whereas changed to be not significant at 6 months and 12 months after operation(P>0.05). On the other hand, the DAA group had significantly lower WOMAC scores at all time points postoperatively than the PLA group(P<0.05). With regard to radiographic assessment, no prosthetic loosening, displacement and breaking were found in anyone of them to the latest follow up. No statistically significant differences were noted in acetabular anteversion, acetabular abduction and femoral off-set(P>0.05). [Conclusion] The DAA has advantages of shortening incision, reducing blood loss and relieving postoperative pain, even improving functional recovery at early stage over the PLA in primary unilateral total hip arthroplasty.更多还原