直接前方入路与后外侧入路全髋关节置换术治疗强直髋Direct anterior versus posterolateral approaches in total hip arthroplasty for ankylosed hip
刘言畅;程文丹;吴晗;张积森;张鑫;张硕;李子煜;吴一博;白文艺;荆珏华;
摘要(Abstract)：
[目的]探讨侧卧位下直接前入路(DAA)和后外侧入路(PLA)全髋关节置换治疗强直性髋关节的临床效果。[方法]回顾性分析2016年11月～2019年5月在本科THA治疗强直性髋关节患者26例(37髋)。其中采用侧卧体位下直接前方入路(DAA) 12例(17髋),后外侧入路(PLA) 14例(20髋),比较两组患者临床效果。[结果]术中DAA组中1例发生股骨近端骨折,予以钢丝捆扎固定,无不良后果。PLA组中,2例由于前方软组织松解困难,术中加用前入路切口暴露关节囊。DAA组手术时间显著少于PLA组,且术中失血量显著少于PLA组,差异均有统计学意义(P<0.05)。所有患者均获得随访,时间6～24个月。随访期间DAA组未发生不良事件。而PLA组有2例发生髋关节后脱位,后在麻醉辅助下手法复位,之后未再发生脱位。随时间延长,两组患者ROM和Harris评分均显著增加,不同时间点间差异均有统计学意义(P<0.05)。但相应时间点相应活动方向,两组间的差异均无统计学意义(P>0.05)。未发生感染、深静脉血栓、脂肪栓塞、假体松动和肢体长度不等等并发症。[结论]强直性髋关节患者进行全髋关节置换术时,侧卧位DAA入路可以直视下松解髋关节前方挛缩的软组织,髋臼暴露充分,利于假体正确安装,且创伤更小,利于髋关节功能的早期恢复,术后脱位发生率低。
关键词(KeyWords)： 强直髋;全髋关节置换;直接前方入路;侧卧位;后外侧入路
基金项目(Foundation): 安徽省科技厅重点研究与开发计划项目(编号：1804h08020269)
作者(Author): 刘言畅;程文丹;吴晗;张积森;张鑫;张硕;李子煜;吴一博;白文艺;荆珏华;
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