直接前路全髋置换是否修复前侧关节囊比较

Primary total hip arthroplasty through direct anterior approach with or without repair of anterior capsule

摘要:

[目的]比较直前方关节入路（direct anterior approach, DAA）初次全髋关节置换（total hip arthroplasty, THA）是否缝合前关节囊的临床结果。[方法]2022 年 1 月—2022 年 7 月在本科采用 DAA 行初次 THA 的 205 患者纳入本研究，依据医患沟通结果，将患者分为两组，其中切除组 102 例，修复组 103 例。比较两组患者围手术期、随访及影像结果。[结果]两组患者手术时间、切口长度、术中失血量、下地行走时间、切口愈合情况、住院时间的差异均无统计学意义（P＞0.05）。所有患者均获随访 1 年以上，两组患者恢复完全负重时间的差异无统计学意义（P＞0.05）。与术前相比，术后 1 年切除组和修复组患者 VAS 评分 [(6.8±1.1), (0.05±0.2), P＜0.001; (6.6±1.1), (0.04±0.2), P＜0.001]、Harris 评分 [(42.7±5.9), (94.7±1.9), P＜0.001; (41.7±6.1), (94.9±1.6), P＜0.001]、髋伸-屈 ROM [(48.1±16.6)°, (122.0±5.4)°, P＜0.001; (47.1±14.7)°, (121.9±4.6)°, P＜0.001]、内-外旋 ROM [(35.7±14.1)°, (81.4±4.2)°, P＜ 0.001; (32.7±13.9)°, (81.1±5.2)°, P＜0.001] 均显著增改善，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）。两组术后髋臼外展角、髋臼前倾角、双侧股骨长度差及股骨假体位置的差异无统计学意义（P＞0.05）。[结论]DAA 入路初次 THA 切除与缝合前关节囊对于患者的临床效果没有影响。对于初学者来说，广泛切除关节囊更有利于髋臼的显露和手术的顺利进行。

Abstract:

[Objective] To compare the clinical results of primary total hip arthroplasty through direct anterior approach with or without repair of anterior capsule. [Methods] From January 2022 to July 2022, a total of 205 patients who underwent primary THA by DAA approach in our department were included in this study. According to doctor-patient communication, 102 patients had the anterior capsule resected completely, while other 103 patients had the capsule repaired after prosthetic placement. The documents regarding to perioperative period, follow-up and images were compared between the two groups. [Results] There were no significant differences in operation time, incision length, intraoperative blood loss, postoperative walking time, incision healing grade and hospital stay between the two groups (P＞0.05). All patients were followed up for more than 1 year, and there was no statistically significant difference in the time to regain full weight bearing between the two groups (P＞0.05). Compared with those preoperatively, the patients in both resection group and the repair group got significant improvements in terms of VAS score [(6.8±1.1), (0.05±0.2), P＜0.001; (6.6±1.1), (0.04±0.2), P＜0.001], Harris score [(42.7±5.9), (94.7± 1.9), P＜0.001; (41.7±6.1), (94.9±1.6), P＜0.001], hip flexion-extension ROM [(48.1±16.6)°, (122.0±5.4)°, P＜0.001; (47.1±14.7)°, (121.9± 4.6)°, P＜0.001], internal-external rotation ROM [(35.7±14.1)°, (81.4±4.2)°, P＜0.001; (32.7±13.9)°, (81.1±5.2)°, P＜0.001]. However, there was no significant difference in the above indexes between the two groups at any corresponding time points (P＞0.05). Radiographically, there were no significant differences in acetabular abduction angle, acetabular anteversion angle, bilateral femoral length difference and femoral prosthetic position between the two groups (P＞0.05). [Conclusion] In primary THA through DAA, anterior capsule resection or repair by suture has no remarkable impact on the clinical outcome. For beginners, extensive removal of the capsule is more conducive to expose the acetabulum and smooth surgical operation.