直接前入路和后外侧入路全髋关节置换术早期功能康复的比较研究

被引：52

作者：

赵海燕 ^{[1
]}

夏亚一 ^{[2
]}

康鹏德 ^{[1
]}

聂涌 ^{[1
]}

裴福兴 ^{[1
]}

沈彬 ^{[1
]}

杨静 ^{[1
]}

周宗科 ^{[1
]}

石小军 ^{[1
]}

王浩洋 ^{[1
]}

曾羿 ^{[1
]}

刘欣 ^{[1
]}

机构：

[1] 成都, 四川大学华西医院骨科

[2] 兰州大学第二医院骨科

来源：

中华骨科杂志 | 2017年 / 37卷 / 19期

关键词：

关节成形术, 置换, 髋; 康复; 步态;

D O I：

暂无

中图分类号：

R687.4 [关节手术];

学科分类号：

100220 [骨科学];

摘要：

目的探讨直接前入路(direct anterior approach, DAA)和后外侧入路(posterolateral approach, PLA)对全髋关节置换术组织损伤及早期功能康复的影响。方法回顾性分析2015年9月至2016年3月68例接受全髋关节置换术患者的资料, 男27例, 女41例。按手术入路分组:DAA组35例, 年龄(54.88±12.13)岁;PLA组33例, 年龄(53.18±14.72)岁。比较两组手术切口长度、手术时间、术中出血量、肌酸激酶(Serum creatinekinase, CK)、C反应蛋白(C-reactive protein, CRP)、红细胞沉降率(erythrocyte sedimentation rate, ESR)、白介素-6(interleukin-6, IL-6)、疼痛视觉模拟评分(visual analogue scale, VAS)、Harris髋关节功能评分、加利福尼亚大学洛杉矶分校(The University of California at Los Angeles, UCLA)评分、术后住院时间、步态参数、影像学指标及并发症等。结果 DAA组手术切口长度较PLA组短[(11.23±0.97)cm与(15.16±1.12)cm]、手术时间较PLA组长[(73.77±9.20)min与(64.12±13.31)min]、术中出血量较PLA组大[(157.15±35.83)ml与(126.97±45.45)ml]、术后住院时间较PLA组短[(2.95±0.24)d与(3.35±0.51)d]。DAA组术后CK、CRP、ESR、IL-6值均低于PLA组。术后72 h内DAA组疼痛VAS评分低于PLA组, 两组差异有统计学意义。两组患者均随访6个月, 术后3个月时DAA组Harris髋关节功能评分、UCLA评分及步态参数均优于PLA组, 术后6个月两组差异无统计学意义。X线片上髋臼前倾角DAA组(16.4°±2.3°)较PLA组(20.4°±2.8°)小。DAA组1例术中出现股骨大转子尖部无移位骨折, PLA组无早期并发症发生。结论 DAA全髋关节置换术肌肉损伤小, 术后疼痛症状轻, 术后住院时间短, 早期髋臼假体稳定性更好, 更有利于早期髋关节功能康复, 但术中出血量大, 手术时间相对较长。

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