| 徐咸咸,陈红梅,罗静枝,朱春兰,刘卫峰.全髋关节置换术中直接前入路与后外侧入路的疗效比较及对假体位置和血清疼痛介质的影响[J].,2022,(12):2303-2307 |
| 全髋关节置换术中直接前入路与后外侧入路的疗效比较及对假体位置和血清疼痛介质的影响 |
| Comparison the Efficacy of Direct Anterior Approach and Posterolateral Approach in Total Hip Arthroplasty and Their Effects on Prosthesis Position and Serum Pain Mediators |
| 投稿时间：2021-11-22 修订日期：2021-12-17 |
| DOI：10.13241/j.cnki.pmb.2022.12.021 |
| 中文关键词: 全髋关节置换术 直接前入路 后外侧入路 疗效 假体位置 疼痛介质 |
| 英文关键词: Total hip arthroplasty Direct anterior approach Posterolateral approach Efficacy Prosthesis position Pain mediators |
| 基金项目:江苏省卫生计生委面上项目（H2017087） |
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| 中文摘要: |
| 摘要 目的：对比全髋关节置换术（THA）中直接前入路（DAA）与后外侧入路（PLA）的疗效，并分析两种入路方式对假体位置和血清疼痛介质的影响。方法：选取2019年3月-2021年7月我院收治的80例THA患者，据入路方式的不同将患者分为PLA组37例和DAA组43例，对比两组手术相关指标、髋关节功能评分、疼痛评分、影像学指标、步态参数、血清疼痛介质水平、并发症发生率。结果：DAA组的切口长度、术后下地时间短于PLA组，手术时间长于PLA组，术后引流量、术中出血量少于PLA组（P<0.05）。两组术后3个月、术后6个月Harris髋关节功能评分均升高，视觉疼痛模拟评分法（VAS）评分均下降（P<0.05）；DAA组术后3个月、术后6个月Harris 髋关节功能评分高于PLA组，VAS评分低于PLA组（P<0.05）。DAA组臼杯位于安全区的比例高于PLA组（P<0.05）；两组髋臼外展角、髋臼前倾角、股骨假体居中率组间对比无差异（P>0.05）。DAA组的单腿支撑时间长于PLA组，步频大于PLA组，Foot off高于PLA组（P<0.05）。两组术后7 d 5-羟色胺（5-HT）、一氧化氮（NO）、前列腺素E2（PGE2）水平均较术前升高（P<0.05）；DAA组术后7 d的5-HT、PGE2、NO水平低于PLA组（P<0.05）。两组术后并发症发生率对比无差异（P>0.05）。结论：THA患者采用DAA的入路方式，除手术时间较长外，其在手术切口、术中损伤、髋关节功能恢复、步态参数、减轻术后疼痛、臼杯位于安全区的比例等方面均优于PLA，且不会增加并发症发生率。 |
| 英文摘要: |
| ABSTRACT Objective: To compare the efficacy of direct anterior approach (DAA) and posterolateral approach (PLA) in total hip arthroplasty (THA), and to analyze the effects of the two approaches on prosthesis position and serum pain mediators. Methods: 80 patients with THA who were treated in our hospital from March 2019 to July 2021 were selected. According to different approaches, the patients were divided into PLA group with 37 cases and DAA group with 43 cases. The operation related indexes, hip function score, pain score, imaging indexes, gait parameters, serum pain mediators levels and the incidence of complications were compared between the two groups. Results: In DAA group, the incision length and postoperative time to the ground were shorter than those in PLA group, the operation time was longer than that in PLA group, and the postoperative drainage volume and intraoperative bleeding volume were less than those in PLA group (P<0.05). Harris hip function score increased at 3 months and 6 months after operation, and visual analogue pain scale (VAS) score decreased in two groups (P<0.05). At 3 months and 6 months after operation, Harris hip function score in DAA group was higher than that in PLA group, and VAS score was lower than that in PLA group (P<0.05). The proportion of acetabular cup in safe area in DAA group was higher than that in PLA group (P<0.05). There were no differences in acetabular abduction angle, acetabular anteversion angle and femoral prosthesis centering rate between the two groups (P>0.05). The single leg support time in DAA group was longer than that in PLA group, the step frequency was higher than that in PLA group, and the Foot off was higher than that in PLA group (P<0.05). The 5-hydroxytryptamine (5-HT), nitric oxide (NO) and prostaglandin E2 (PGE2) levels in the two groups at 7 d after operation increased compared with those before operation (P<0.05). The 5-HT, PGE2 and NO levels in DAA group at 7 d after operation were lower than those in PLA group (P<0.05). There was no difference in the incidence of postoperative complications between the two groups (P>0.05). Conclusion: In patients with THA, DAA approach is superior to PLA in surgical incision, intraoperative injury, hip joint functional recovery, gait parameters, relief of postoperative pain, proportion of acetabular cup in the safe area and other aspects, in addition to longer operation time, without increasing the incidence of complications. |
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