侧卧位直前入路全髋关节置换的近期疗效

Short-term outcome of total hip arthroplasty through direct anterior approach in lateral decubitus position

摘要:

[目的] 评价侧卧位直前入路全髋关节置换（total hip arthroplasty, THA） 的近期疗效。[方法] 本院2022 年10 月—2023 年9 月对50 例患者行THA。依据术前医患沟通结果，25 例采用侧卧位直前入路（direct anterior approach, DAA），另外25例采用传统后外侧入路（posterolateral approach, PLA）。比较两组患者短期临床和影像资料。[结果] 两组患者均顺利完成手术，无严重并发症。DAA 组在手术时间[(48.5±2.2) min vs (63.9±3.9) min, P＜0.001]，切口长度[(7.8±3.1) cm vs (10.4±3.2) cm, P=0.005]、术中失血量[(222.0±39.8) ml vs (292.3±53.6) ml, P＜0.001]、下地行走时间[(2.1±0.5) d vs (3.5±0.9) d, P＜0.001]、住院天数[(5.1±1.0) d vs (8.1±1.7) d, P＜0.001] 均显著优于PLA 组。所有患者均获随访6 个月以上。与出院时相比，末次随访时，两组患者VAS 评分和Harris 评分显著改善（P＜0.05）。末次随访时，DAA 组的VAS 评分[(1.6±1.1) vs (2.5±1.5), P=0.033] 和Harris 评分[(81.2±11.6) vs (72.5±9.9), P=0.007] 均显著优于PLA 组。术后影像显示，两组患者假体位置良好，两组间术后髋臼前倾角及外展角的差异均无统计学意义（P＞0.05）。[结论] 与传统后外侧入路相比，侧卧位直前入路全髋关节置换术可减少手术创伤，更有利于患者早期恢复。

Abstract:

[Objective] To evaluate the short-term efficacy of total hip arthroplasty (THA) through direct anterior approach in lateraldecubitus position. [Methods] A total of 50 patients received THA in our hospital from October 2022 to September 2023. Based on preoper-ative patient communication, 25 patients had THA performed through the direct anterior approach (DAA) in lateral decubitus position,while other 25 patients were through the traditional posterolateral approach (PLA). Short-term clinical and imaging data were compared be-tween the two groups. [Results] All patients in both groups were successfully operated on without serious complications. The DAA groupproved significantly superior to the PLA group in terms of operation time [(48.5±2.2) min vs (63.9±3.9) min, P＜0.001], incision length [(7.8±3.1) cm vs (10.4±3.2) cm, P=0.005], intraoperative blood loss [(222.0±39.8) ml vs (292.3±53.6) ml, P＜0.001], ambulation time [(2.1±0.5)days vs (3.5±0.9) days, P＜0.001], and hospitalization [(5.1±1.0) days vs (8.1±1.7) days, P＜0.001]. All the patients were followed up for morethan 6 months. Compared with those at discharge, the VAS scores and Harris scores significantly improved in both groups at the last followup(P＜0.05). At the last follow-up, the DAA group was significantly better than the PLA group regarding VAS score [(1.6±1.1) vs (2.5±1.5),P=0.033] and Harris score [(81.2±11.6) vs (72.5±9.9), P=0.007]. Postoperative images showed that the prosthetic position was good in allpatients of both groups, and there were no significant differences in acetabular anterior inclination and abduction angle between the twogroups (P＞0.05). [Conclusion] Compared with the traditional posterolateral approach, the direct anterior approach in lateral decubitus posi-tion does reduce surgical trauma, and is more beneficial to early recovery.