【摘要】 目的:探讨侧卧位直接前方入路全髋关节置换术治疗发育性髋关节发育不良的疗效，并观察术后脊柱-骨盆X线片变化情况。方法:回顾性分析2015年6月至2022年6月在承德医学院附属医院关节外科接受人工全髋关节置换手术的82例DDH患者。依据手术入路不同，分为直接前方入路组和后外侧入路组。比较两组患者年龄、髋关节分型、性别、患侧、切口长度、手术时间、住院天数、术后引流量及并发症发生情况。记录直接前方入路组及后外侧入路组患者术前、术后3d、14d及1、3、12、24个月髋关节Harris评分、视觉模拟量表(VAS)评分，测量髋关节外展及屈曲角度。在站立位X线片上测量术前及术后1个月骶骨倾斜角、髂骨倾斜角及髋关节倾斜角变化情况。结果:两组患者在切口长度、手术时间、住院天数、术后引流量以及并发症的发生比较差异有统计学意义(P<0.05),DAA组均优于PLA组。直接前方入路组、后外侧入路组患者术前及术后不同时间段髋关节Harris评分、VAS评分、髋关节外展及屈曲角度的变化有统计学意义(P<0.05),两组患者术后髋关节Harris评分、髋关节外展及屈曲角度较术前比较明显增加，术后VAS评分较术前明显降低；两组患者全髋关节置换术后骶骨倾斜角、髂骨倾斜角及髋关节倾斜角较术前显著降低(P<0.001)。直接前方入路组与前外侧入路组在术前及术后不同时间段Harris评分、VAS评分、髋关节外展及屈曲角度比较差异无统计学意义(P>0.05)。结论:采用侧卧位直接前方入路的方式进行人工全髋关节置换手术来治疗发育性髋关节发育不良疗效显著，可改善DDH患者骨盆倾斜程度。更多还原

【Abstract】 Objective: To investigate the efficacy of direct anterior approach total hip arthroplasty in the treatment of developmental dysplasia of the hip in the lateral decubitus position and to observe changes in postoperative spinal-pelvic X-ray images. Methods: A total of 82 patients with DDH who underwent total hip arthroplasty in the Department of Joint Surgery of the Affiliated Hospital of Chengde Medical University from June 2015 to June 2022 were retrospectively analyzed. According to the different surgical approaches, they were divided into a direct anterior approach group and a posterolateral approach group. The age, hip joint classification, gender, affected side, incision length, operation time, hospital stay, postoperative drainage volume, and complications of the two groups were compared. The Harris hip score and visual analogue scale(VAS) score of patients in the direct anterior approach group and the posterolateral approach group were recorded preoperatively, 3d, 14d postoperatively, and 1, 3,12and 24 months postoperatively, and the hip abduction and flexion angles were measured. The changes of sacrum tilt angle, iliac tilt angle, and hip joint tilt angle were measured on standing position X-ray film before and 1 month after operation. Results:There were statistically significant differences in incision length, operation time, hospital stay, postoperative drainage volume, and complications between the two groups(P<0.05), and DAA group had better results than PLA group. The changes of hip Harris score, VAS score, hip abduction and flexion angle in the direct anterior approach group and posterolateral approach group at different time points before and after operation were statistically significant(P<0.05). The hip Harris score, hip abduction and flexion angle in the two groups after operation were significantly increased compared with those before operation, and the postoperative VAS score was significantly decreased compared with those before operation. After total hip arthroplasty, the sacral tilt angle, iliac tilt angle and hip joint tilt angle of the two groups were significantly lower than those before operation(P<0.001). There was no significant difference in Harris score, VAS score, hip abduction, and flexion angle between the direct anterior approach group and the anterolateral approach group at different time points before and after operation(P > 0.05). Conclusion: The direct anterior approach total hip arthroplasty in the lateral decubitus position demonstrates significant efficacy in treating developmental dysplasia of the hip and improves pelvic tilt in patients with developmental dysplasia of the hip.更多还原