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中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (03) : 280 -285. doi: 10.3877/cma.j.issn.1674-134X.2020.03.004

所属专题: 文献

临床论著

直接前方入路全髋关节置换术治疗强直性髋关节炎
郭立成1, 徐杰1,()   
  1. 1. 350001 福州,福建医科大学省立临床医学院;350001 福州,福建省立医院
  • 收稿日期:2019-11-19 出版日期:2020-06-01
  • 通信作者: 徐杰
  • 基金资助:
    福建省卫生健康青年科研课题(2019-2-2); 福建省立医院火石基金项目(2019HSJJ24); 福建医科大学启航基金(2018QH1162)

Total hip arthroplasty via direct anterior approach in treatment of ankylosed hips

Licheng Guo1, Jie Xu1,()   

  1. 1. Provincial Clinical Medical College of Fujian Medical University, Fuzhou 350001, China; Fujian Provincial Hospital, Fuzhou 350001, China
  • Received:2019-11-19 Published:2020-06-01
  • Corresponding author: Jie Xu
  • About author:
    Corresponding author: Xu Jie, Email:
引用本文:

郭立成, 徐杰. 直接前方入路全髋关节置换术治疗强直性髋关节炎[J]. 中华关节外科杂志(电子版), 2020, 14(03): 280-285.

Licheng Guo, Jie Xu. Total hip arthroplasty via direct anterior approach in treatment of ankylosed hips[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(03): 280-285.

目的

探讨直接前方入路全髋关节置换术在治疗强直性髋关节炎中的临床效果。

方法

回顾性分析2015年10月至2018年10月于福建省立医院行全髋关节置换术的强直性髋关节炎62例(66髋),纳入强直性脊柱炎合并髋关节炎行全髋关节置换的患者,排除脊柱畸形严重患者。根据手术入路分为直接前入路组和后外侧入路组,比较手术切口长度,术中出血量的差异,通过Harris髋关节功能评分、影像学评价两组患者手术效果。计量资料采用t检验,计数资料采用卡方检验。

结果

直接前入路组和后外侧入路组在手术切口长度和术中出血量的差异无统计学意义(t=1.346、1.272,均为P>0.05)。末次随访平均(25±11)个月,所有患者均解除疼痛,恢复髋关节活动功能。直接前入路组Harris评分术前平均(61±14)分,术后平均(97.8±2.9)分。后外侧入路组Harris评分术前平均(59.3±14.3)分,术后平均(97.4±3.3)分。两组组内术后Harris评分均明显高于术前(t=14.229、14.729, P<0.001),但两组间差异无统计学意义(t =0.416, P>0.05)。术后X线片两组均无骨溶解及假体松动等征象,未发生术后并发症。

结论

直接前方入路全髋关节置换治疗强直性髋关节炎的临床效果满意。

Objective

To evaluate the clinical outcomes of total hip arthroplasty via direct anterior approach in the treatment of ankylosed hips.

Methods

A retrospective analysis was performed on the data of 62 patients (66 hips) treated with total hip arthroplasty for ankylosed hips from October 2015 to October 2018 in Fujian Provincial Hospital. The patients with ankylosing spondylitis and hip arthritis were included and the patients with severe spinal deformity were excluded. According to the surgical approach, the patients were divided into direct anterior approach group and posterolateral approach group. The incision length, bleeding volume, Harris score and X-ray evaluation were used to evaluate the hip function of the two groups. Chi-square test was performed in count data and t test was used for measurement data.

Results

No significant differences were found in incision length and bleeding volume between the two groups(t=1.346, 1.272, both P>0.05). In the latest follow-up for an average of (25±11) months, all patients were relieved of pain. In the direct anterior approach group, the preoperative average Harris score was (61±14)and the postoperative average score was (97.8±2.9). In the posterolateral approach group, the preoperative average Harris score was (59.3±14.3)and the postoperative average score was (97.4±3.3). The postoperative average Harris score was significantly superior to the preoperative average score in both two groups (t=14.229, 14.729, P<0.001). However, there was no significant differences between the two groups (t=0.416, P>0.05). There was no osteolysis and loosening signs in X-ray in both two groups and no complication was found during the follow-up.

Conclusion

The clinical outcomes of total hip arthroplasty via direct anterior approach in the treatment of ankylosed hips are satisfactory.

图1 直接前入路组手术步骤。图A示将耻骨联合对准手术床调节中心部位;图B为显露股骨颈;图C为股骨颈截骨;图D为取出截骨块及股骨头;图E为髋臼锉打磨髋臼;图F为打磨完毕的髋臼;图G为折叠手术床使髋关节过伸并内收外旋股骨;图H为髓腔锉扩髓;图I为置入股骨柄及股骨头假体试模;图J为复位髋关节;图K为术后的手术切口
表1 患者术前情况比较
表2 手术切口及出血情况比较(±s)
表3 组内Harris髋关节评分对比(±s)
图2 典型病例1(直接前方入路组)的术前术后骨盆X线正位片。图A术前骨盆正位片,可见双侧髋关节骨性强直,骨盆前倾;图B右髋术后3 d骨盆正位片,假体位置良好;图C左髋术后3 d骨盆正位片,假体位置良好;图D术后3个月骨盆正位片,双侧髋关节假体位置无变化
图3 典型病例2(后外侧入路组)手术前后图片。图A为术前骨盆X线正位片,可见左髋关节间隙变窄,骨性强直;图B为术中手术切口;图C为术后3 d骨盆X线正位片,可见左髋关节假体位置良好;图D为术后4年骨盆X线正位片,示左髋关节假体位置无变化,假体周围无透亮线,右髋关节骨性强直
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