| 许瀚,石波,李宗原,等.直接前方入路全髋关节置换术学习曲线及其前后疗效分析.骨科,2020,11(4): 274-280. |
| 直接前方入路全髋关节置换术学习曲线及其前后疗效分析 |
| Analysis of the learning curve and clinical outcomes of early and late cases of total hip arthroplasty by direct anterior approach |
| 投稿时间：2020-01-04 |
| DOI：10.3969/j.issn.1674-8573.2020.04.002 |
| 中文关键词: 关节成形术，置换，髋 手术入路 学习曲线 |
| 英文关键词: Arthroplasty, replacement, hip Surgical approach Learning curve |
| 基金项目:绵阳市科技计划项目（18YFZJ0048） |
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| 中文摘要: |
| 目的 研究采用直接前方入路（direct anterior approach, DAA）行全髋关节置换术（total hip arthroplasty, THA）的临床疗效，探讨直接前方入路全髋关节置换术（DAA-THA）的学习曲线及其前后期疗效。方法 回顾性分析2018年5月至2019年5月在绵阳市中心医院行DAA-THA的105例病人的手术时间、术中出血量、切口引流量、手术前后血红蛋白（hemoglobin, HGB）及白蛋白（albumin, ALB）差值、住院时间、术后假体位置（外展角、前倾角、股骨柄-髓腔轴线夹角）、肢体长度差（limb length discrepancy, LLD）、并发症及Harris髋关节功能评分等临床资料，探讨该术式学习曲线，比较分析学习曲线前后病例的上述各项指标。结果 病例均获得随访，随访时间为6~18个月，平均12个月。病人手术时间为（136.88±34.52） min，术中出血量为（248.43±131.44） ml，术后引流量为（233.07±122.35） ml，HGB差值为（27.16±11.01） g/L，ALB差值为（10.72±3.94） g/L，住院时间为（8.61±3.96） d。术后Harris评分为（79.82±5.95）分，前倾角为14.24°±5.62°，外展角为42.57°±7.25°，股骨柄-髓腔轴线夹角为2.66°±1.59°，LLD为（5.11±3.82） mm。手术时间、术中出血量、假体安放位置、住院时间在完成54例DAA-THA后趋于稳定。以54例为界，分为前期组（54髋）和后期组（51髋）。DAA-THA后期组的手术时间、术中出血量、住院时间、外展角、股骨柄-髓腔轴线夹角小于前期组，差异均有统计学意义（P均＜0.05）。DAA-THA前期组与后期组在术后引流量、HGB差值、ALB差值、前倾角、LLD、术后1、3、6个月Harris髋关节功能评分方面的差异均无统计学意义（P均＞0.05）。两组均无假体脱位发生，DAA-THA后期组的并发症发生率小于前期组，差异有统计学意义（P＜0.05）。结论 DAA-THA学习曲线为54例左右，度过学习曲线后，DAA-THA手术技术在多方面更加稳定与成熟，可以有效地减少手术时间及术中出血量，提高假体安放的准确性，缩短住院时间，降低并发症的发生，从而为病人提供更优的术后早期疗效。 |
| 英文摘要: |
| Objective To analyze the clinical outcomes of direct anterior approach (DAA) of total hip arthroplasty (THA), explore the learning curve of DAA-THA and its clinical outcomes before and after the learning curve. Methods A retrospective analysis was performed on 105 cases treated with DAA-THA from May 2018 and May 2019 in Mianyang Central Hospital. The operation time, intraoperative blood loss, wound drainage, the difference of hemoglobin (HGB) and albumin (ALB) before and after operation, hospital stay, postoperative prosthesis position (acetabular abduction angle, anteversion angle, angle between prostheses' longitudinal axis and femoral anatomical axis), limb length discrepancy (LLD), complications, and Harris score were collected. The learning curve of operation was explored and the above indexes were comparatively analyzed. Results All patients were followed up for 6-18 months (mean 12 months). The operation time was (136.88±34.52) min, the intraoperative blood loss was (248.43±131.44) ml, the postoperative drainage volume was (233.07±122.35) ml, the HGB difference was (27.16±11.01) g/L, ALB difference was (10.72±3.94) g/L, hospital stay was (8.61±3.96) d. Postoperative Harris score was 79.82±5.95, anterior anteversion angle was 14.24°±5.62°, abduction angle was 42.57°±7.25°, angle between prostheses' longitudinal axis and femoral anatomical axis was 2.66°±1.59°, and LLD was (5.11±3.82) mm. Operation time, intraoperative blood loss, postoperative prosthesis position and hospital stay tended to be stable after the completion of 54 cases of DAA-THA. The 105 cases were divided into the early group (54 hips) and the late group (51 hips). In the late group, the operative time, intraoperative blood loss, hospital stay, acetabular abduction angle, angle between prostheses' longitudinal axis and femoral anatomical axis were significantly reduced as compared with those in the early group (all P＜0.05). There was no significant difference in postoperative drainage volume, HGB difference, ALB difference, anteversion angle, LLD, Harris score at 1sr, 3rd and 6th month after surgery between the early group and the late group (P＞0.05). No dislocation of prosthesis occurred in the two groups, and the incidence of complications in the late group was significantly lower than that in the early group (P＜0.05). Conclusion The learning curve of DAA-THA was about 54 cases. After passing the learning curve, DAA-THA surgical technique is more stable and mature in many aspects, which can effectively reduce the operative time and intraoperative blood loss, improve the accuracy of prosthetic placement, shorten the length of hospital stay, reduce the occurrence of complications, so as to provide better early postoperative outcomes for patients. |
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