切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 157 -162. doi: 10.3877/cma.j.issn.1674-134X.2021.02.005

所属专题： 文献；

临床论著

不同入路全髋关节置换术治疗股骨头缺血性坏死
张其亮1, 于瑜2, 周健1, 滕学仁1, 任国清1,†()   
  1. 1. 266071　青岛市市立医院骨关节与运动医学科
    2. 266071　青岛市市立医院中心手术室
  • 收稿日期:2020-04-03 出版日期:2021-04-01
  • 通信作者: 任国清
  • 基金资助:
    青岛市2019年度医药科技指导计划(2019-WJZD020)

Clinical effects comparison of total hip arthroplasty with different approaches for treatment of femoral head necrosis

Qiliang Zhang1, Yu Yu2, Jian Zhou1, Xueren Teng1, Guoqing Ren1,†()   

  1. 1. Department of Joint and Sports Medicine, Qingdao Municipal Hospital, Qingdao 266071, China
    2. Department of central operating room, Qingdao Municipal Hospital, Qingdao 266071, China
  • Received:2020-04-03 Published:2021-04-01
  • Corresponding author: Guoqing Ren
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

张其亮, 于瑜, 周健, 滕学仁, 任国清. 不同入路全髋关节置换术治疗股骨头缺血性坏死[J]. 中华关节外科杂志(电子版), 2021, 15(02): 157-162.

Qiliang Zhang, Yu Yu, Jian Zhou, Xueren Teng, Guoqing Ren. Clinical effects comparison of total hip arthroplasty with different approaches for treatment of femoral head necrosis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(02): 157-162.

目的

评估直接前入路与后侧入路全髋关节置换术治疗股骨头坏死患者的临床效果差异。

方法

选择符合全髋关节置换指征的初次单侧Ficat分期Ⅲ、Ⅳ期股骨头坏死患者160例为研究对象，排除双侧手术、术前有髋部疾病及既往外伤史的患者，随机分为直接前入路组(DAA)和后侧入路组(PA)，每组80例患者。分别按照不同入路行人工全髋关节置换手术，术后1年、2年对两组患者的并发症情况、假体位置、Harris髋关节功能评分(Harris评分)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、简式36项健康调查问卷(SF-36)及关节遗忘指数等进行观察和比较。采用独立样本t检验及重复测量方差分析进行统计学分析。

结果

共有128例患者获得超过2年随访。两组患者的基线资料比较差异无统计学意义(P>0.05)。术后2年两组患者的髋臼外翻角和前倾角、股骨偏心距及并发症发生情况比较，差异无统计学意义(t＝0.834、0.883、1.733，均为P>0.05; Fisher精确检验P＝1.000)；两组患者术后1年、2年的Harris评分差异无统计学意义(F＝2.309、2.965，均为P>0.05)；术后1年DAA组的WOMAC评分(F＝4.699，P＝0.034)、身体成分摘要(PCS)(F＝4.525，P＝0.037)和心理成分摘要(MCS)评分(F＝8.906，P＝0.004)均显著优于PA组；两组患者术后2年的WOMAC评分、MCS和PCS评分差异无统计学意义(F＝2.349、2.608、0.513，均为P>0.05)。两组患者术后1年、2年的关节遗忘指数差异有统计学意义(F＝4.832，P＝0.032)，DAA组的关节遗忘指数显著高于PA。

结论

DAA入路与PA入路比较，在术后并发症以及假体位置方面无差异，但在改善患者术后1年内功能恢复，尤其是主观感觉方面具有一定优势。术后2年，DAA组在自我感觉方面仍有优势，更长期的效果差异还需要进一步观察和更全面的评估。

关键词: 成形, 置换, 髋, 手术伤口, 股骨头坏死
Objective

To compare the clinical outcomes of direct anterior approach (DAA) and posterior approaches (PA) for primary unilateral total hip arthroplasty (THA) in the treatment of femoral head necrosis.

Methods

A total of 160 Ficat stageⅢ、Ⅳfemoral head necrosis patients who were undergoing primary unilateral THA were included into this study. Patients with bilateral surgery, preoperative hip disease, and previous trauma history were excluded. All the patients were divided into two groups by the random method. The operations were performed according to DAA and PA approaches. The complications, prosthesis location, Harris score, the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, short-form 36 item health survey questionnaire (SF-36) and forgotten joint score-12 were observed and compared between the two groups one and two years after operation. Independent sample t test and repeated measures analysis of variance were used for statistical analysis.

Results

A total of 128 patients were followed up for more than two years. There was no significant difference in baseline data between the two groups (P>0.05). There was no significant difference in acetabular anteversion, acetabular abduction and femoral off-set and complications between the two groups at two years post-operatively (t=0.834, 0.883, 1.733, all P>0.05; Fisher exact test P=1.000). There was no significant difference in Harris score between the two groups one and two years after operation(F=2.309, 2.965, both P>0.05). There were significant differences in WOMAC(F=4.699, P=0.034), mental component summary (MCS)(F=8.906, P=0.004) and physical component summary (PCS)(F=4.525, P=0.037) between the two groups at one year after operation.The WOMAC, MCS and PCS in DAA group were significantly higher than those in PA group. There was no significant difference in WOMAC, MCS and PCS scores between the two groups two years after operation (F=2.349, 2.608, 0.513, all P>0.05). There was significant difference in forgotten joint score-12 between the two groups one and two years after operation (F=4.832, P=0.032). The forgotten joint score-12 of DAA group was significantly higher than PA group.

Conclusions

Compared with PA approach, DAA approach has no difference in postoperative complications and prosthesis position, but it has some advantages in functional recovery, especially subjective feeling, within one year after operation. Two years after operation DAA still shows an advantage in self-perception. Long term differences in outcome requires further observation and more comprehensive evaluation.

Key words: Arthroplasty, replacement, hip, Surgical wound, Femur head necrosis
表1 两组患者术前基线资料
  DAA组 PA组 统计值 P值
例数 62 66    
年龄[岁，(±s)] 61.7±7.1 63.3±8.2 t＝1.199 >0.05
性别(男/女) 35/27 40/26 χ2＝0.227 >0.05
BMI[%，(±s)] 24.6±3.0 25.0±3.4 t＝0.758 >0.05
股骨头坏死        
  FicatⅢ期 21 19 χ2＝0.384 >0.05
  FicatⅣ期 41 47
ASA分级        
  Ⅰ级 15 19 χ2＝0.400 >0.05
  Ⅱ级 34 35
  Ⅲ级 13 12
术前合并症        
  高血压 19 21 χ2＝0.020 >0.05
  冠心病 13 12 χ2＝0.158 >0.05
  糖尿病 10 13 χ2＝0.276 >0.05
  COPD 4 3 χ2＝0.007 >0.05
  其他 7 9 χ2＝0.161 >0.05
表2 两组患者术后功能评分情况(±s)
  DAA组 PA组 F值 P值
例数 62 66    
Harris评分        
术前 43.5±5.2 44.3±6.3 0.145 >0.05
  术后1年 92.2±3.0 91.4±3.6 2.309 >0.05
  术后2年 93.3±2.0 92.8±2.1 2.965 >0.05
WOMAC评分        
  术前 69.8±6.9 70.4±7.0 0.139 >0.05
  术后1年 3.7±0.8 4.1±0.9 4.699 0.034
  术后2年 1.7±0.3 1.8±0.4 2.349 >0.05
PCS评分        
  术前 27.0±7.4 27.5±7.0 0.174 >0.05
  术后1年 47.2±5.4 44.8±5.5 8.906 0.004
  术后2年 52.7±6.4 50.6±6.9 0.513 >0.05
MCS评分        
  术前 48.7±7.4 50.1±8.5 2.524 >0.05
  术后1年 54.8±6.9 51.9±6.6 4.525 0.037
  术后2年 56.2±6.1 55.2±6.5 2.608 >0.05
FJS评分        
  术后1年 70.5±19.4 61.2±21.5 0.059 >0.05
  术后2年 75.3±15.5 68.2±22.3 4.832 0.032
表3 两组患者术后假体位置情况(±s)
分组 例数 髋臼假体外翻角度(°) 髋臼假体前倾角度(°) 股骨柄偏心距(mm)
DAA组 62 43±6 24±4 38±4
PA组 66 44±7 24±4 39±4
t值   0.834 0.883 1.733
P值   >0.05 >0.05 >0.05
[1]
Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement[J]. Lancet, 2007, 370(9597): 1508-1519.
[2]
den Daas A, Reitsma EA, Knobben BAS, et al. Patient satisfaction in different approaches for total hip arthroplasty[J]．Orthop Traumatol Surg Res，2019, 105(7):1277-1282.
[3]
Radoicic D, Zec V, Elassuity WI, et al. Patient′s perspective on direct anterior versus posterior approach total hip arthroplasty[J]. Int Orthop, 2018, 42(12): 2771-2775.
[4]
Rodriguez JA, Deshmukh AJ, Rathod PA, et al. Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach？[J]．Clin Orthop Relat Res, 2014,472(2):455-463.
[5]
Taunton MJ, Trousdale RT, Sierra RJ, et al. John Charnley Award: randomized clinical trial of direct anterior and miniposterior approach THA: which provides better functional recovery？[J]．Clin Orthop Relat Res, 2018,476(2):216-229.
[6]
Kucukdurmaz F, Sukeik M, Parvizi J. A meta-analysis comparing the direct anterior with other approaches in primary total hip arthroplasty[J]. Surgeon, 2019, 17(5): 291-299.
[7]
Pradhan R. Planar anteversion of the acetabular cup as determined from plain anteroposterior radiographs[J]. J Bone Joint Surg Br, 1999, 81(3): 431-435.
[8]
Pivec R, Johnson AJ, Mears SC, et al. Hip arthroplasty[J]. Lancet, 2012, 380(9855): 1768-1777.
[9]
Anakwe RE, Jenkins PJ, Moran M. Predicting dissatisfaction after total hip arthroplasty: a study of 850 patients[J]. J Arthroplasty, 2011, 26(2): 209-213.
[10]
Jones CA, Beaupre LA, Johnston DW, et al. Total joint arthroplasties: current concepts of patient outcomes after surgery[J]. Clin Geriatr Med, 2005, 21(3): 527-541, vi.
[11]
Sutphen S, Berend KR, Morris MJ, et al. Direct anterior approach has lower deep infection frequency than less invasive direct lateral approach in primary total hip arthroplasty[J]. J Surg Orthop Adv, 2018, 27(1): 21-24.
[12]
Moretti VM, Post ZD. Surgical approaches for total hip arthroplasty[J]. Indian J Orthop, 2017, 51(4): 368-376.
[13]
Jia F, Guo B, Xu F, et al. A comparison of clinical, radiographic and surgical outcomes of total hip arthroplasty between direct anterior and posterior approaches: a systematic review and meta-analysis[J]. Hip Int, 2019, 29(6): 584-596.
[14]
Zhao HY, Kang PD, Xia YY, et al. Comparison of early functional recovery after total hip arthroplasty using a direct anterior or posterolateral approach: a randomized controlled trial[J]. J Arthroplasty, 2017, 32(11): 3421-3428.
[15]
Liebs TR, Herzberg W, Gluth J, et al. Using the patient′s perspective to develop function short forms specific to total hip and knee replacement based on WOMAC function items[J]. Bone Joint J, 2013, 95-B(2): 239-243.
[16]
Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty[J]. J Arthroplasty, 2013, 28(9): 1634-1638.
[17]
Elibol N, Unver B, Karatosun V, et al. Relationship between self-reported and performance-based tests in assessment of patients with total hip arthroplasty[J]. Hip Int, 2018, 28(5):566-570.
[18]
Umehara N, Mitani S, Namba Y. Factors influencing health-related quality of life after total hip arthroplasty[J]．Acta Med Okayama, 2016,70(2):89-95.
[19]
Maldonado DR, Kyin C, Walker-Santiago R, et al. Direct anterior approach versus posterior approach in primary total hip replacement: comparison of minimum 2-year outcomes[published online ahead of print, 2019 Oct 20][J/OL]．Hip Int, 2019, 2019: 1120700019881937. doi:10.1177/1120700019881937.
[20]
Ozaki Y, Baba T, Homma Y, et al. Posterior versus direct anterior approach in total hip arthroplasty: difference in patient-reported outcomes measured with the forgotten joint score-12[J/OL]. SICOT J, 2018, 4:54. doi:10.1051/sicotj/201805.
[1] 周钰菡, 肖欢, 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷. 超声对儿童髋关节暂时性滑膜炎的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 795-800.
[2] 中华医学会骨科学分会关节外科学组, 广东省医学会骨质疏松和骨矿盐疾病分会, 广东省佛山市顺德区第三人民医院. 中国髋部脆性骨折术后抗骨质疏松药物临床干预指南(2023年版)[J]. 中华关节外科杂志(电子版), 2023, 17(06): 751-764.
[3] 许正文, 李振, 侯振扬, 苏长征, 朱彪. 富血小板血浆联合植骨治疗早期非创伤性股骨头坏死[J]. 中华关节外科杂志(电子版), 2023, 17(06): 773-779.
[4] 金鑫, 谢卯, 刘芸, 杨操, 杨述华, 许伟华. 个性化股骨导向器辅助初次全髋关节置换的随机对照研究[J]. 中华关节外科杂志(电子版), 2023, 17(06): 780-787.
[5] 邓华梅, 袁札根, 曾德荣, 潘珊珊, 张葆青, 欧爱华, 曹学伟. 全膝关节置换术中气压止血带应用效果与影响因素分析[J]. 中华关节外科杂志(电子版), 2023, 17(06): 788-794.
[6] 张思平, 刘伟, 马鹏程. 全膝关节置换术后下肢轻度内翻对线对疗效的影响[J]. 中华关节外科杂志(电子版), 2023, 17(06): 808-817.
[7] 李培杰, 乔永杰, 张浩强, 曾健康, 谭飞, 李嘉欢, 王静, 周胜虎. 细菌培养阴性的假体周围感染诊治的最新进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 827-833.
[8] 林文, 王雨萱, 许嘉悦, 王矜群, 王睿娜, 何董源, 樊沛. 人工关节置换登记系统的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 834-841.
[9] 闫文, 谢兴文, 顾玉彪, 雷宁波, 马成, 于文霞, 高亚雄, 张磊. 微小RNA与全膝关节置换术后深静脉血栓的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 842-846.
[10] 贺敬龙, 尚宏喜, 郝敏, 谢伟, 高明宏, 孙炜, 刘安庆. 重度类风湿关节炎患者行多关节置换术的临床手术疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 860-864.
[11] 孟繁宇, 周新社, 赵志, 裴立家, 刘犇. 侧位直接前方入路髋关节置换治疗偏瘫肢体股骨颈骨折[J]. 中华关节外科杂志(电子版), 2023, 17(06): 865-870.
[12] 汪帮琦, 陈波特, 林浩坚, 许晖阳, 王镇伟, 袁雪峰, 林康健, 邱晓拂. 经腹入路3D腹腔镜联合输尿管硬镜同期处理肾盂输尿管连接部梗阻并肾盏结石的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 597-600.
[13] 中华医学会骨科分会关节学组. 中国髋、膝关节置换日间手术围手术期管理专家共识[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 321-332.
[14] 付庆鹏, 邓晓强, 高伟, 姜福民, 范永峰, 吴海贺, 齐岩松, 包呼日查, 徐永胜. 新型股骨测量定位器在全膝关节置换术中的临床应用[J]. 中华临床医师杂志(电子版), 2023, 17(9): 980-987.
[15] 李岩松, 李涛, 张元鸣飞, 李志鹏, 周谋望. 头戴式虚拟现实设备辅助全膝关节置换术后康复的初步研究[J]. 中华临床医师杂志(电子版), 2023, 17(06): 676-681.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号