背景:目前微创全髋关节置换逐渐发展并成为全髋关节置换的代表性术式之一,而直接前侧入路具有组织损伤小、术后并发症较低、术后恢复快等优点,但是与其他入路相比较而言,该入路是否可获取更优的早期、远期疗效还存在较大争议.目的:对比直接前侧入路与后外侧常规入路微创全髋关节置换的临床疗效.方法:选择2015年9月至2016年9月于南京中医药大学附属常州市中医医院骨一科行微创全髋关节置换的患者88例,按照修复入路将其分为后外侧常规入路组及直接前侧入路组,每组44例.记录并比较2组患者手术切口长度、手术时间、置换后引流量、输血量、置换前后血红蛋白差值、下床行走时间,术后髋臼外展角和髋臼前倾角,置换后红细胞沉降率和 C-反应蛋白水平,并发症(感染、血管损伤、髋关节脱位等),以及术前、术后1,3,6个月的髋关节功能Harris评分等.结果与结论:①2组患者术后髋臼外展角和髋臼前倾角差异无显著性意义(P > 0.05);②直接前侧入路组患者的手术时间明显长于后外侧常规入路组(P < 0.05);而直接前侧入路组患者的手术切口长度、术中出血量、置换后引流量、血红蛋白差值、置换后红细胞沉降率、置换后C-反应蛋白以及下床行走时间均明显小于后外侧常规入路组(P < 0.05);③直接前侧入路组患者置换后1,3个月Harris评分明显高于后外侧常规入路组(P < 0.05);2组患者置换前和置换后6个月的Harris评分差异均无显著性意义(P > 0.05);④2组患者在置换后并发症方面差异无显著性意义(P > 0.05);⑤结果提示,后外侧常规入路和直接前侧入路微创全髋关节置换的随访6个月疗效和置换后并发症发生率无明显差异;但直接前侧入路手术创伤更小,患者术后恢复更快,关节稳定性更高,更符合微创手术和快速康复理念的要求.%BACKGROUND: At present, minimally invasive total hip arthroplasty is gradually developed, and becomes one of the representative types of total hip arthroplasty. The direct anterior approach is characterized by small tissue injury, low postoperative complications and rapid postoperative recovery. Compared with other approaches, there is still a lot of controversy on whether the approach can obtain better early and long-term effects. OBJECTIVE: To compare the clinical effect of direct anterior approach and posterolateral approach in minimally invasive total hip arthroplasty. METHODS: Totally 88 patients with minimally invasive total hip arthroplasty from September 2015 to September 2016 in the First Department of Orthopedics, Changzhou City Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine were selected as the subjects. The patients were divided into direct anterior approach group and posterolateral approach group, with 44 patients in each group. The incision length, operation time, postoperative drainage volume, blood transfusion volume, hemoglobin difference before and after operation, time of bed walking, postoperative acetabular abduction angle and acetabular anteversion angle were recorded and compared. Blood sedimentation rate, C-reactive protein levels, complications (infection, vascular injury and hip dislocation), hip function Harris score preoperatively, postoperatively 1, 3, and 6 months were analyzed. RESULTS AND CONCLUSION: (1) There was no significant difference in the postoperative acetabular abduction angle and acetabular anteversion angle between both groups (P > 0.05). (2) The average operation time of the patients in the direct anterior approach group was significantly longer than that in the posterolateral approach group (P < 0.05). The length of incision, intraoperative blood loss, postoperative drainage volume, hemoglobin difference, postoperative erythrocyte sedimentation rate, postoperative C-reactive protein and time of bed walking were significantly lower in direct anterior approach group than in posterolateral approach group (P < 0.05). (3) Harris score of direct anterior approach group was significantly higher than that of posterolateral approach group (P < 0.05). There was no significant difference in Harris score between the two groups before and 6 months after operation (P > 0.05). (4) There was no significant difference in postoperative complications between the two groups (P > 0.05). (5) There is no significant difference in the efficacy during 6-month follow-up and postoperative complications between posterolateral approach and direct anterior approach, but the direct anterior approach is less traumatic, with faster postoperative recovery, higher joint stability, more consistent with minimally invasive surgery and the concept of rapid rehabilitation.
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