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。

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。

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。

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。

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.

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.

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.

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.