【摘要】 目的 探讨直接前入路(DAA)与后入路(PA)全髋关节置换术(THA)中长期的临床治疗效果。方法 选取2019-01-01-2022-02-28河南省南阳市第二人民医院行THA治疗的患者77例。其中36例行DAA(DAA-THA组),41例行PA(PA-THA组)。比较2组患者自由行走、正常爬楼、正常穿鞋和袜患者例数。次要终点：比较2组患者术中及术后早期相关指标；术后远期视觉模拟评分法(VAS评分)、6分钟步行实验(6MWT)指标及并发症发生情况。结果 DAA-THA组患者所需的手术时间(81.52±15.44) min、切口长度(13.45±1.02) cm、术中出血量(391.68±123.47) mL均高于PA-THA组患者(62.74±11.22) min、(12.24±1.42) cm、(212.88±98.68) mL,差异有统计学意义，t值分别为6.16、4.24、7.06,均P<0.001;DAA-THA组患者住院时间(12.27±1.68) d短于PA-THA组患者(13.52±2.14) d,差异有统计学意义，t=2.845,P=0.006;DAA-THA组患者的6MWT术后即刻(42.87±32.74) m、术后1 d(169.74±86.27) m、术后2 d(224.17±87.69) m高于PA-THA组患者(21.76±24.68) m、(128.75±90.11) m、(168.34±80.52) m,差异有统计学意义，t值分别为3.22、2.03、2.91,P值分别为0.002、0.046、0.005;DAA-THA组患者术后1个月的自由行走(28/36)、正常爬楼(21/36)、正常穿鞋和袜(30/36)的比例高于PA-THA组患者(23/41)、(11/41)、(9/41),差异有统计学意义，均P<0.05;DAA-THA组患者术后1个月的HHS评分功能(28.89±3.67)分、总分(91.25±9.48)分高于PA-THA组患者(26.14±4.67)分、(83.47±8.67)分，差异有统计学意义，均P<0.05。2组患者并发症总发生率相当，均为8.3%,差异无统计学意义，P>0.05。结论 DAA-THA术式能在术中较好地保护髋部周围肌肉、软组织，能在早期快速改善患者的髋部功能。更多还原

【Abstract】 Objective To explore the medium and long-term clinical treatment efficacy of total hip arthroplasty(THA) between direct anterior approach(DAA) and posterior approach(PA).Methods A total of 77 patients who received THA treatment at The Second People’s Hospital of Nanyang City,Henan Province,from January 1,2019,to February 28,2022,were selected.Of these,36 had DAA(DAA-THA group) and 41 had PA(PA-THA group).The number of patients who could walk freely,climb stairs normally,and wear shoes and socks normally were compared between the two groups.Secondary endpoints:intraoperative and early postoperative indicators related indicators were compared between the two groups;long-term postoperative visual analog score(VAS score),6-minute walking experiment(6 MWT) and occurrence of complications were compared.Results The required operation time(81.52±15.44) min,incision length(13.45±1.02) cm,intraoperative blood loss(391.68±123.47) ml in the DAA-THA group were higher than those in the PA-THA group(62.74±11.22) min,(12.24±1.42) cm,(212.88±98.68) ml,with statistically significant differences,t-values were 6.16,4.24,7.06,all P<0.001;The length of hospital stay of patients in the DAA-THA group(12.27±1.68) d was shorter than that of patients in the PA-THA group(13.52±2.14) d,and the difference was statistically significant,t=2.845,P=0.006;The 6 MWT immediately after surgery(42.87±32.74) m,1 d after surgery(169.74±86.27) m,2 d after surgery(224.17±57.69) m in the DAA-THA group were higher than those in the PATHA group(21.76±24.68) m,(128.75±90.11) m,(168.34±80.52) m,with statistically significant differences,t-values were 3.22,2.03,2.91,P=0.002,0.046,0.005;the proportion of patients who could walk freely(28/36),climb stairs normally(21/36),and wear shoes and socks normally(30/36) in the DAA-THA group was higher than that in the PA-THA group(23/41),(11/41),(9/41),with statistically significant differences,all P<0.05;HHS score function(28.89±3.67) and total score(91.25±9.48) of DAA-THA group were higher than those of PA-THA group(26.14±4.67) and(83.47±8.67),and the difference was statistically significant,all P<0.05.The overall incidence of complications was similar between the two groups,both at 8.3%,with no significant difference,P>0.05.Conclusion The DAA-THA can better protect the muscles and soft tissue around the hip,and can quickly improve the hip function in the early stage.更多还原