| 乔高山,顾英骏,朱乐银,等.前路辅助上方关节囊入路全髋关节置换对髋臼假体位置及术后早期髋关节功能的影响.骨科,2023,14(6): 517-522. |
| 前路辅助上方关节囊入路全髋关节置换对髋臼假体位置及术后早期髋关节功能的影响 |
| Effect of Total Hip Arthroplasty via Anterior Superpath Approach on Acetabular Prosthesis Position and Early Postoperative Hip Function |
| 投稿时间：2023-03-29 |
| DOI：10.3969/j.issn.1674-8573.2023.06.006 |
| 中文关键词: 关节成形术，置换，髋 前路辅助上方关节囊入路 直接前入路 后外侧入路 髋臼假体位置 对比研究 |
| 英文关键词: Arthroplasty, replacement, hip Anterior SuperPATH Direct anterior approach Posterolateral approach Acetabular cup positioning Comparative study |
| 基金项目:江苏省卫生健康委员会科研项目（Z2022017）；扬州市科技计划项目（YZ2022120） |
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| 中文摘要: |
| 目的 探讨前路经皮辅助上方关节囊入路（Anterior SuperPATH）行人工全髋关节置换术（THA）对髋臼假体位置及早期髋关节功能的影响。方法 回顾性分析2019年11月至2022年6月在我院行THA的75例病人的临床资料，根据手术入路不同分为两组，38例采用前路经皮辅助上方关节囊入路的病人纳入前路通道组，37例采用传统后外侧入路的病人纳入后外侧组。记录并比较两组手术时间、术中出血量、术后卧床时间、住院时间、术后24 h疼痛视觉模拟量表（VAS）评分，以及术后1周、1个月的髋关节Harris评分。术后拍摄骨盆正位X线片，测量髋臼假体的外展角与前倾角，并与Lewinnek安全区（髋臼外展角40°±10°、髋臼前倾角15°±10°）进行比较，评估放置髋臼假体的准确性。结果 病人随访8~21个月，平均为12.1个月。所有病人术后6个月均未见脱位。前路通道组手术时间长于后外侧组，手术出血量少于后外侧组，术后卧床时间与住院时间短于后外侧组，术后24 h的VAS评分低于后外侧组，术后1周、1个月的髋关节Harris评分高于后外侧组，两组比较，差异均有统计学意义（P＜0.05）。前路通道组的外展角和前倾角分别为42.78°±4.98°、15.29°±4.97°，二者均在安全区域的比例为84.2%（32/38）；后外侧组的外展角和前倾角分别为41.49°±5.50°、13.58°±4.74°，二者均在安全区域的比例为83.8%（31/37）；两组间比较，差异均无统计学意义（P＞0.05）。结论 采用前路经皮辅助上方关节囊入路和后外侧入路行THA，髋臼假体位置无明显差异。虽然前路经皮辅助上方关节囊入路手术时间更长，但能明显减少手术出血，缓解手术疼痛，缩短住院时间，加速康复。 |
| 英文摘要: |
| Objective To discuss the effect of total hip arthroplasty (THA) via anterior SuperPATH approach on acetabular prosthesis position and early postoperative hip function. Methods From November 2019 to June 2022, 75 patients undergoing THA were included in the study. They were divided into two groups based on different surgical approaches: 38 patients using the Anterior SuperPATH approach were included in the anterior path group, and 37 patients using the traditional posterolateral approach were included in the posterolateral group. The following data were compared between two groups: the operation time, the intraoperative blood loss, postoperative bed rest time, hospital stay, visual analogue scale (VAS) score 24 h after operation and the Harris scores at 1 week and 1 month postoperatively. The acetabular inclination angle and acetabular anteversion angle were measured through postoperative radiographs of pelvis, which was compared with Lewinnek's safe range (acetabular inclination angle: 40°±10°; acetabular anteversion angle: 15°±10°), and the accuracy of acetabular position was investigated. Results The patient was followed up for 8-21 months, with an average of 12.1 months. None of the patients had been dislocated for 6 months after surgery. The operation time was longer, the amount of bleeding was less, and the postoperative bed rest time and hospitalization time were shorter, postoperative 24 h hip pain VAS score was lower, the Harris scores at 1st week and 1st month postoperatively were higher in the anterior path group than those in the posterolateral group, with the difference between the two groups being statistically significant (P＜0.05). The acetabular inclination angle and acetabular anteversion angle in the anterior channel group were 42.78°±4.98° and 15.29°±4.97°, respectively, with a proportion of 84.2% (32/38) in the target safe zone; the acetabular inclination angle and acetabular anteversion angle in the posterolateral group were 41.49°±5.50° and 13.58°±4.74°, with a proportion of 83.8% (31/37) in the target safe zone; there was no statistically significant difference between the two groups (P＞0.05). Conclusion There is no significant differences in the acetabulum position during THA between the anterior SuperPATH and posterolateral approaches. Although the operation time is longer, the anterior SuperPATH approach for THA can significantly reduce surgical bleeding, relieve surgical pain, shorten hospitalization time and obtain fast recovery. |
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