| 微创直接前入路与传统后外侧入路全髋关节置换治疗股骨头坏死的临床疗效比较 |
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Received:March 20, 2016
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| 作者 | Author | 单位 | Unit | E-Mail |
| 俞银贤 |
YU Yin-xian |
上海交通大学附属第一人民医院骨科, 上海 200080 |
Department of Orthopaedics Surgery, the First Affiliated Hospital of Shanghai Jiao Tong University, Shanghai 200080, China |
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| 易诚青 |
YI Cheng-qing |
上海交通大学附属第一人民医院骨科, 上海 200080 |
Department of Orthopaedics Surgery, the First Affiliated Hospital of Shanghai Jiao Tong University, Shanghai 200080, China |
ycq3000@163.com |
| 马金忠 |
MA Jin-zhong |
上海交通大学附属第一人民医院骨科, 上海 200080 |
Department of Orthopaedics Surgery, the First Affiliated Hospital of Shanghai Jiao Tong University, Shanghai 200080, China |
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| 王秋根 |
WANG Qiu-gen |
上海交通大学附属第一人民医院创伤中心, 上海 200080 |
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| 期刊信息：《中国骨伤》2016年29卷，第8期，第702-707页 |
| DOI：10.3969/j.issn.1003-0034.2016.08.006 |
| 基金项目:国家自然科学基金面上项目（编号：81371979） |
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| 目的：对比在学习曲线阶段的微创直接前入路（direct anterior approach，DAA）与传统后外侧入路全髋关节置换治疗股骨头坏死患者的临床疗效，以评估微创直接前入路在股骨头坏死全髋关节置换中的运用价值。方法：2008年1月至2009年12月全髋关节置换手术治疗48例股骨头坏死Ficat Ⅲ或Ⅳ期患者，患者主要表现为髋关节疼痛，活动受限。其中DAA组21例，男11例，女10例，平均年龄（65.2±4.3）岁；后外侧入路组27例，男16例，女11例，平均年龄（63.6±4.0）岁。比较两组患者的手术时间、术中出血量、术后卧床时间及术后并发症，术后1个月时测量髋臼杯外展角及股骨柄假体颈干角。术后1、6个月和5年时分别采用Harris髋关节功能评分（HHS）和视觉模拟评分法（VAS）评定髋关节功能及患髋疼痛情况。结果：所有患者术后获随访，平均60.4个月（48～73个月）.手术时间DAA组为（78.30±5.08）min，后外侧入路组为（75.61±10.60）min，术中出血量DAA组为（351.30±21.46）ml，后外侧入路组为（362.20±26.15）ml，两组差异无统计学意义。术后卧床时间DAA组为（2.05±1.10）d，后外侧组为（3.30±1.35）d，差异有统计学意义。术后1个月时髋臼杯外展角和股骨柄假体颈干角差异无统计学意义。术后1、6个月及5年，两组HHS与髋关节疼痛VAS 评分差异均无统计学意义。DAA组有1例术中损伤旋股外侧动脉升支，1例大转子骨折，1例表浅伤口感染。后外侧组发生1例髋关节后脱位。两组末次随访时均无假体松动。结论：采用微创DAA与传统后外侧入路全髋关节置换术治疗股骨头坏死Ficat Ⅲ期或Ⅳ期均可以获得较好疗效，但在学习曲线阶段，针对复杂病例微创DAA较传统的后外侧入路其优势可能并不明显。 |
| [关键词]:股骨头坏死 关节成形术,置换,髋 直接前入路 学习曲线 病例对照研究 |
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| Comparison of the effect of total hip arthroplasty through mini-invasive direct anterior approach during learning curve period and posterolateral approach for the treatment of femoral head necrosis |
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| Abstract:Objective: To compare clinical results of treating femoral head necrosis staged Ficat Ⅲ or Ⅳ with total hip arthroplasty(THA) between mini-invasive direct anterior approach(DAA) and posterolateral approach. Methods: From January 2008 to December 2009,48 patients with femoral head necrosis staged Ficat Ⅲ or Ⅳ treated with THA were compared and analyzed. There were 21 patients in mini-invasive direct anterior approach group including 11 males and 10 females with an average age of (65.2±4.3) years old;while there were 27 patients in posterolateral approach group including 16 males and 11 females with an average age of (63.6±4.0) years old. Operative time,blood loss during operation,bed rest time and complications of two groups were observed and compared. Acetabular abduction and stem shaft angle were measured 1 month after operation and compared between two groups. Postoperative Harris Hip scoring and VAS scoring were applied for evaluating hip function and pain at 1,6 months and 5 years after operation respectively. Results: All patients were followed up for 48 to 73 months with an average of 60.4 months. Operative time,blood loss in DAA group was (78.30±5.08) min,(351.30±21.46) ml,respectively,in posterolateral approach group was(75.61±10.60) min,(362.20±26.15) ml,and no significant differences between two groups. Bed rest time in DAA group was (2.05±1.10) days,better than that of in posterolateral approach which was (3.30±1.35) days. No significant differences were found between two groups in acetabular abduction and stem shaft angle at 1 month after operation. There was no significant differences between two groups in HHS and VAS score at 1,6 months and 5 years after operation. There was 1 case with injury of ascending branch of the lateral circumflex femoral artery,1 case with great trochanter fracture and 1 case with superficial infection in DAA group,1 case with dislocation in posterolateral group. No prosthesis loosening occurred in two groups. Conclusion: Both DAA and posterolateral approach are effective in treating femoral head necrosis staged Ficat Ⅲ or Ⅳ,and could obtain excellent outcomes. However,DAA seemed to has disadvantage in learing curve compared posteriolateral approach in complex cases. |
| KEYWORDS:Femoral head necrosis Arthroplasty,replacement,hip Direct anterior approach Learning curve Case-control studies |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 俞银贤,易诚青,马金忠,王秋根.微创直接前入路与传统后外侧入路全髋关节置换治疗股骨头坏死的临床疗效比较[J].中国骨伤,2016,29(8):702~707 |
| 英文格式: | YU Yin-xian,YI Cheng-qing,MA Jin-zhong,WANG Qiu-gen.Comparison of the effect of total hip arthroplasty through mini-invasive direct anterior approach during learning curve period and posterolateral approach for the treatment of femoral head necrosis[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(8):702~707 |
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