[1]董玉鹏,季卫锋,尚美妍,等.支架辅助下直接前方入路微创全髋关节置换术治疗发育性髋关节发育不良[J].中医正骨,2018,30(10):30-35.
 DONG Yupeng,JI Weifeng,SHANG Meiyan,et al.Minimal invasive total hip arthroplasty through direct anterior approach assisted by supporting frame for treatment of developmental dysplasia of hip[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(10):30-35.
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支架辅助下直接前方入路微创全髋关节置换术治疗发育性髋关节发育不良()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年10期
页码:
30-35
栏目:
临床研究
出版日期:
2018-10-20

文章信息/Info

Title:
Minimal invasive total hip arthroplasty through direct anterior approach assisted by supporting frame for treatment of developmental dysplasia of hip
作者:
董玉鹏1季卫锋2尚美妍1曾森炎1张洋1沈景2
(1.浙江中医药大学,浙江 杭州 310053; 2.浙江省中医院,浙江 杭州 310006)
Author(s):
DONG Yupeng1JI Weifeng2SHANG Meiyan1ZENG Senyan1ZHANG Yang1SHEN Jing2
1.Zhejiang University of Traditional Chinese Medicine,Hangzhou 310053,Zhejiang,China 2.Zhejiang Provincial Hospital of Traditional Chinese Medicine,Hangzhou 310006,Zhejiang,China
关键词:
髋脱位先天性 关节成形术置换 手术入路
Keywords:
hip dislocationcongenital arthroplastyreplacementhip operative approach
摘要:
目的:比较支架辅助下直接前方入路(direct anterior approach,DAA)与传统后侧入路微创全髋关节置换术治疗发育性髋关节发育不良(developmental dysplasia of hip,DDH)的临床疗效和安全性。方法:回顾性分析50例DDH患者的病例资料,其中采用支架辅助下DAA微创全髋关节置换术治疗25例(DAA组),采用传统后侧入路微创全髋关节置换术治疗25例(传统后侧入路组)。男26例,女24例。年龄39~77岁,中位数58岁。CroweⅠ型27例,CroweⅡ型23例。比较2组患者的手术时间、切口长度、术中出血量、术后引流量、术后首次下地时间和术后住院时间,以及术前和术后1周、1个月、3个月、6个月、1年、2年时2组患者的Harris髋关节功能评分,观察并发症发生情况。结果:DAA组患者的切口长度、术后住院时间和术后首次下地时间均短于传统后侧入路组[(8.54±1.41)cm,(13.24±2.45)cm,t=-8.298,P=0.000;(7.31±1.22)d,(14.83±3.42)d,t=-10.364,P=0.000;(12.14±3.52)h,(25.43±5.77)h,t=-9.832,P=0.000],术中出血量和术后引流量均小于传统后侧入路组[(242.17±32.64)mL,(361.38±53.28)mL,t=-9.542,P=0.000;(80.43±5.87)mL,(102.52±8.50)mL,t=-10.699,P=0.000]; 2组患者手术时间比较,差异无统计学意义[(69.30±4.45)min,(68.41±5.65)min,t=0.623,P=0.541]。Harris髋关节功能评分,时间因素和分组因素存在交互效应(F=4.164,P=0.007); 2组患者Harris髋关节功能评分总体比较,组间差异有统计学意义,即存在分组效应(F=9.327,P=0.048); 手术前后不同时间点之间Harris髋关节功能评分的差异有统计学意义,即存在时间效应(F=31.356,P=0.000); 2组患者Harris髋关节功能评分随时间均呈升高趋势,但2组的升高趋势不完全一致[(41.41±2.43)分,(70.59±2.60)分,(78.23±3.37)分,(87.16±4.18)分,(92.52±4.76)分,(93.14±3.86)分,(93.21±4.71)分,F=17.631,P=0.000;(40.73±2.96)分,(62.87±4.28)分,(71.59±2.20)分,(82.87±6.33)分,(91.04±3.42)分,(92.47±4.64)分,(93.17±3.69)分,F=28.382,P=0.000]; 术前和术后6个月、1年、2年,2组患者Harris髋关节功能评分的组间差异均无统计学意义(t=0.888,P=0.379; t=1.263,P=0.213; t=0.555,P=0.581; t=0.033,P=0.973); 术后1周、1个月和3个月,DAA组患者Harris髋关节功能评分均高于传统后侧入路组(t=7.708,P=0.000; t=8.249,P=0.000; t=2.828,P=0.007)。2组患者均未出现并发症。结论:与传统后侧入路微创全髋关节置换术相比,采用支架辅助下DAA微创全髋关节置换术治疗DDH,创少小,住院时间短,能使患者尽早下床锻炼,早期髋关节功能恢复快,可作为临床治疗DDH的一种较为理想的方法。但二者在手术时间和远期髋关节功能恢复方面无明显差异。
Abstract:
Objective:To compare the clinical curative effects and safety of minimal invasive total hip arthroplasty(THA)through direct anterior approach(DAA)assisted by supporting frame versus conventional posterior approach(CPA)for treatment of developmental dysplasia of hip(DDH).Methods:The medical records of 50 patients with DDH were analyzed retrospectively.Twenty-five patients were treated with minimal invasive THA through DAA assisted by supporting frame(DAA group),while the others were treated with minimal invasive THA through CPA(CPA group).The patients consisted of 26 males and 24 females,and ranged in age from 39 to 77 years(Median=58 yrs).The DDH belonged to Crowe typeⅠ(27)and Ⅱ(23).The operative time,incision length,intraoperatve blood loss,postoperative drainage,bed rest time,postoperative hospital stay and Harris hip function scores before the surgery and at 1 week,1 month,3 months,6 months,1 year and 2 years after the surgery were compared between the 2 groups,and the complications were observed.Results:The incision length,postoperative hospital stay and bed rest time were shorter and the intraoperatve blood loss and postoperative drainage were less in DAA group compared to CPA group(8.54+/-1.41 vs 13.24+/-2.45 cm,t=-8.298,P=0.000; 7.31+/-1.22 vs 14.83+/-3.42 d,t=-10.364,P=0.000; 12.14+/-3.52 vs 25.43+/-5.77 hrs,t=-9.832,P=0.000; 242.17+/-32.64 vs 361.38+/-53.28 mL,t=-9.542,P=0.000; 80.43+/-5.87 vs 102.52+/-8.50 mL,t=-10.699,P=0.000).There was no statistical difference in operative time between the 2 groups(69.30+/-4.45 vs 68.41+/-5.65 min,t=0.623,P=0.541).There was interaction between time factor and group factor in Harris hip function scores(F=4.164,P=0.007).There was statistical difference in Harris hip function scores between the 2 groups in general,in other words,there was group effect(F=9.327,P=0.048).There was statistical difference in Harris hip function scores between different timepoints before and after the surgery,in other words,there was time effect(F=31.356,P=0.000).The Harris hip function scores presented a time-dependent increasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the increasing trend of Harris hip function scores(41.41+/-2.43,70.59+/-2.60,78.23+/-3.37,87.16+/-4.18,92.52+/-4.76,93.14+/-3.86,93.21+/-4.71 points,F=17.631,P=0.000; 40.73+/-2.96,62.87+/-4.28,71.59+/-2.20,82.87+/-6.33,91.04+/-3.42,92.47+/-4.64,93.17+/-3.69 points,F=28.382,P=0.000).There was no statistical difference in Harris hip function scores between the 2 groups before the surgery and at 6 months,1 year and 2 years after the surgery(t=0.888,P=0.379; t=1.263,P=0.213; t=0.555,P=0.581; t=0.033,P=0.973).The Harris hip function scores were higher in DAA group compared to CPA group at 1 week,1 month and 3 months after the surgery(t=7.708,P=0.000; t=8.249,P=0.000; t=2.828,P=0.007).No complications were found in the 2 groups.Conclusion:Minimal invasive THA through DAA assisted by supporting frame has such advantages as less trauma,shorter hospital stay,shorter bed rest time and faster hip function recovery compared to minimal invasive THA through CPA in treatment of DDH,so it can be used as an ideal therapy for treatment of DDH in clinic.However,there is no obvious difference between the two therapies in operative time and long-term hip function recovery.

参考文献/References:


[1] POST ZD,OROZCO F,DIAZ-LEDEZMA C,et al.Direct anterior approach for total hip arthroplasty:indications,technique,and results[J].J Am Acad Orthop Surg,2014,22(9):595-603.
[2] CONNOLLY KP,KAMATH AF.Direct anterior total hip arthroplasty:Comparative outcomes and contemporary results[J].World J Orthop,2016,7(2):94-101.
[3] SHETH D,CAFRI G,INACIO MC,et al.Anterior and anterolateral approaches for THA are associated with lower dislocation risk without higher revision risk[J].Clin Orthop Relat Res,2015,473(11):3401-3408.
[4] WEBER T,AL-MUNAJJED AA,VERKERKE GJ,et al.Influence of minimally invasive total hip replacement on hip reaction forces and their orientations[J].J Orthop Res,2014,32(12):1680-1687.
[5] HIGGINS BT,BARLOW DR,HEAGERTY NE,et al.Anterior vs posterior approach for total hip arthroplasty,a systematic review and meta-analysis[J].J Arthroplasty,2015,30(3):419-434. 中医正骨2018年10月第30卷第10期 J Trad Chin Orthop Trauma,2018,Vol.30,No.10(总755) (总756)中医正骨2018年10月第30卷第10期 J Trad Chin Orthop Trauma,2018,Vol.30,No.10
[6] 康鹏德,沈彬,裴福兴.直接前方入路全髋关节置换术[J].中华骨科杂志,2016,36(15):1002-1008.
[7] CROWE JF,MANI VJ,RANAWAT CS.Total hip replacement in congenital dislocation and dysplasia of the hip[J].J Bone Joint Surg Am,1979,61(1):15-23.
[8] 中华医学会骨科学分会.发育性髋关节发育不良诊疗指南(2009年版)[J].中国矫形外科杂志,2013,21(9):953-954.
[9] 刘云鹏,刘沂.骨与关节损伤和疾病的诊断分类及功能评定标准[M].北京:清华大学出版社:216-217.
[10] MJAALAND KE,KIVLE K,SVENNINGSEN S,et al.Comparison of markers for muscle damage,inflammation,and pain using minimally invasive direct anterior versus direct lateral approach in total hip arthroplasty:A prospective,randomized,controlled trial[J].J Orthop Res,2015,33(9):1305-1310.
[11] ZAWADSKY MW,PAULUS MC,MURRAY PJ,et al.Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty:150 consecutive cases[J].J Arthroplasty,2014,29(6):1256-1260.
[12] CHENG TE,WALLIS JA,TAYLOR NF,et al.A prospective randomized clinical trial in total hip Arthroplasty-Comparing early results between the direct anterior approach and the posterior approach[J].J Arthroplasty,2017,32(3):883-890.
[13] SIGUIER T,SIGUIER M,BRUMPT B.Mini-incision anterior approach does not increase dislocation rate:a study of 1037 total hip replacements[J].Clin Orthop Relat Res,2004,426:164-173.
[14] 吕明,张金庆,王兴山,等.直接前入路髋关节置换术及其早期临床疗效[J],2017,49(2):206-213.
[15] KAWARAI Y,IIDA S,NAKAMURA J,et al.Does the surgical approach influence the implant alignment in total hip arthroplasty? Comparative study between the direct anterior and the anterolateral approaches in the supine position[J].Int Orthop,2017,41(12):2487-2493.
[16] 严卫锋,曾忠友,裴斐.直接前入路与后外侧入路全髋关节置换术的2年随访结果分析[J].中国中医骨伤科杂志,2017,25(11):59-62.
[17] DEN HARTOG YM,MATHIJSSEN NM,VEHMEIJER SB.The less invasive anterior approach for total hip arthroplasty:a comparison to other approaches and an evaluation of the learning curve—a systematic review[J].Hip Int,2016,26(2):105-120.
[18] JI W,STEWART N.Fluoroscopy assessment during anterior minimally invasive hip replacement is more accurate than with the posterior approach[J].Int Orthop,2016,40(1):21-27.
[19] MCNABB DC,JENNINGS JM,LEVY DL,et al.Direct anterior hip replacement does not pose undue radiation exposure risk to the patient or surgeon[J].J Bone Joint Surg Am,2017,99(23):2020-2025.
[20] DE GEEST T,VANSINTJAN P,DE LOORE G.Direct anterior total hip arthroplasty:complications and early outcome in a series of 300 cases[J].Acta Orthop Belg,2013,79(2):166-173.
[21] MATSUURA M,OHASHI H,OKAMOTO Y,et al.Elevation of the femur in THA through a direct anterior approach:cadaver and clinical studies[J].Clin Orthop Relat Res,2010,468(12):3201-3206.
[22] ITO Y,MATSUSHITA I,WATANABE H,et al.Anatomic mapping of short external rotators shows the limit of their preservation during total hip arthroplasty[J].Clin Orthop Relat Res,2012,470(6):1690-1695.
[23] MACHERAS GA,CHRISTOFILOPOULOS P,LEPETSOS P,et al.Nerve injuries in total hip arthroplasty with a mini invasive anterior approach[J].Hip Int,2016,26(4):338-343.
[24] 俞银贤,易诚青,马金忠,等.微创直接前入路与传统后外侧入路全髋关节置换治疗股骨头坏死的临床疗效比较[J].中国骨伤,2016,29(8):702-707.
[25] HALLERT O,LI Y,BRISMAR H,et al.The direct anterior approach:initial experience of a minimally invasive technique for total hip arthroplasty[J].J Orthop Surg Res,2012,7(1):17.
[26] GROB K,MANESTAR M,ACKLAND T,et al.Potential risk to the superior gluteal nerve during the anterior approach to the hip joint:an anatomical study[J].J Bone Joint Surg Am,2015,97(17):1426-1431.
[27] DE STEIGER RN,LORIMER M,SOLOMON M.What is the learning curve for the anterior approach for total hip arthroplasty?[J].Clin Orthop Relat Res,2015,473(12):3860-3866.

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备注/Memo

备注/Memo:
基金项目:中国博士后科学基金项目(2015M571246)
通讯作者:季卫锋 E-mail:jiweifeng1230@163.com
更新日期/Last Update: 2019-02-25