两种入路行全髋关节置换治疗股骨头坏死比较

Comparison of two approaches of total hip arthroplasty for femoral head necrosis

摘要:

[目的] 比较 SuperPATH 入路与后外侧 （posterolateral approach, PLA） 小切口全髋关节置换术 （total hip arthro- plasty, THA） 治疗股骨头坏死 （osteonecrosis of the femoral head, ONFH） 的疗效。[方法] 2017 年 6 月—2019 年 6 月本院收治的 65 例晚期股骨头坏死 （ONFH） 患者，采用随机数字法将患者分成两组。两组患者均接受 THA 术，其中 35 例采用 SuperPath 入路，另外 30 例采用 PLA 入路。比较两组围手术期、随访与影像资料。[结果] 两组患者均顺利完成手术，术中无神经、血管损伤等严重并发症。SuperPath 组手术时间显著长于 PLA 组 （P＜0.05），但切口总长度、术后下床行走时间及住院时间均显著优于 PLA 组 （P＜0.05）。随访时间均在 24 个月以上，SuperPath 组恢复完全负重活动显著早于 PLA 组 （P＜ 0.05）。随时间推移，两组 VAS 评分均显著下降 （P＜0.05），而 Harris 评分显著增加 （P＜0.05）。术后 6 个月，SuperPath 组的 VAS 和 Harris 评分均明显优于 PLA 组 （P＜0.05），但末次随访时，两组间上述评分的差异无统计学意义 （P＞0.05）。影像方面，与术前相比，末次随访两组髋臼外展角、髋臼前倾角均无显著变化 （P＞0.05），而两组肢体长度差均显著减小 （P＜ 0.05）。相应时间点，两组间上述指标的差异均无统计学意义 （P＞0.05）。[结论] 与 PLA 相比，SuperPATH 入路 THA 术中组织损伤小，有利于术后早期康复。

Abstract:

[Objective] To compare the efficacy of SuperPath approach versus posterolateral approach (PLA) with a small incision for to- tal hip arthroplasty (THA) in the treatment of osteonecrosis of the femoral head (ONFH). [Methods] A total of 65 patients who were admitted to our hospital from June 2017 to June 2019 for end-stage ONFH were divided into two groups by random number method. All the patients in both groups received THA, including 35 patients with SuperPath approach, while the other 30 patients with PLA approach. The periopera- tive, follow- up and radiographic documents were compared between the two groups. [Results] The surgical procedures were successfully completed in both groups without neurovascular injury and other serious complications. Although the SuperPath group consumed significant- ly longer operation time than the PLA group (P＜0.05), the former was significantly superior to the latter in terms of total incision length, time to return walking postoperatively and hospital stay (P＜0.05). The follow-up period lasted for more than 24 months. The SuperPath group re- sumed full weight- bearing activity significantly earlier than the PLA group (P＜0.05). The VAS score significantly decreased (P＜0.05), whereas Harris score significantly increased in both groups over time (P＜0.05). The SuperPath group proved significantly superior to the PLA group in abovesaid scores at 6 months after surgery (P＜0.05), nevertheless, the differences became not statistically significant between the two groups at the latest follow-up (P＞0.05). Regarding to imaging evaluation, there were no significant changes in acetabular abduction and acetabular anteversion (P＞0.05), whereas the discrepancy in limb length significantly decreased at the latest follow-up compared with those preoperatively in both groups (P＜0.05). At corresponding time points, there was no statistical significance in the above radiographic items between the two groups (P＞0.05). [Conclusion] The SuperPath approach has an advantage of minimized iatrogenic trauma over the PLA, which is beneficial to early postoperative recovery.