直接前方入路与后外侧入路初次全髋关节置换的康复疗效比较

关键词：直接前方入路  后外侧入路  髋关节置换  康复

Keywords:direct anterior approach  posterolateral approach  total hip arthroplasty  rehabilitation

摘要：

      摘要 目的：探讨应用直接前方入路(direct anterior approach，DAA) 与后外侧入路(posterolateral approach，PLA)行初次全髋关节置换术(total hip arthroplasty，THA)进行早期康复介入的康复疗效。 方法：2019—2020年间北京积水潭医院矫形骨科收治的初次全髋关节置换患者40例， DAA组20例，PLA组20例，两组患者性别、年龄、诊断等一般资料无显著差异（P>0.05）。在术前及术后1个月、3个月、6个月时采用VAS（visual analogue scale）评价疼痛，采用HHS（Harris hip score）评分系统评价髋关节功能，采用10m步行（10MWT）评价患者行走能力，应用SF-12评价生存质量。数据采用SPSS 22.0统计学软件进行分析。 结果：VAS评分术前两组间无差异，两组患者术后6个月较术前均有明显改善（P<0.05），术后1个月两组间无差异，术后3个月和6个月，DAA组均优于PLA组；Harris评分术前两组无差异，两组患者术后6个月较术前均明显提高（P<0.05），术后1个月、3个月、6个月时DAA组均优于PLA组；10m步行结果术前无差异，两组患者术后6个月较术前均有明显改善（P<0.05），术后1个月、3个月、6个月时DAA组均优于PLA组；SF-12中PCS与MCS评分术前均无明显差异，术后6个月较术前两组均有明显改善（P<0.05），术后1个月、3个月、6个月PCS评分两组均无明显差异，术后1个月、6个月MCS评分两组间无差异，术后3个月时DAA组优于PLA组。 结论：直接前方入路和后外侧入路全髋关节置换术治疗髋关节终末期疾患均有肯定且良好的疗效，前方入路在疼痛、步行能力和功能方面优于后外侧入路，但也要兼顾躯体活动能力和心理健康因素等，在评估术后疗效时建议采用多种量表综合评价。

Abstract:

      Abstract Objective： To investigate the rehabilitation effect of direct anterior approach(DAA) and posterolateral approach (PLA) for primary total hip arthroplasty(THA). Method： From 2019 to 2020， 40 patients with primary total hip arthroplasty， 20 in DAA group and 20 in PLA group， were treated in the orthopaedic department of Beijing Jishuitan Hospital. There was no significant difference in general data such as gender， age and diagnosis between the two groups (P>0.05). Visual analogue scale(VAS) was used to evaluate pain before and 1， 3 and 6 months after operation， HHS(Harris hip score) was used to evaluate hip function， 10 meter walk (10MWT) was used to evaluate walking ability， and SF-12 was used to evaluate quality of life. The data were analyzed by SPSS 22.0. Result： Their functions were no significant difference in any dimension between the two groups before operation. But their improvement after operation were significantly in any dimension and more in DAA group than in PLA group. The VAS score at 3 and 6 months after operation improved more in DAA group than in PLA group (P<0.05). The Harris score increased gradually in both groups, but DAA group increased more than PLA group (P<0.05) at 1,3,6 months after operation . The time to take 10 meter walk reduced gradually and significantly (P<0.001), and the reduce was more in DAA group than in PLA group (P<0.01) at any time point after operation. PCS and MCS scores in SF-12 improved in both groups(P<0.001) , but the DAA group improved more in MCS at 3 months after operation(P<0.05) . Conclusion： Direct anterior approach and posterolateral approach of total hip arthroplasty have positive and good effects in the treatment of end-stage hip diseases. The anterior approach is better than the posterolateral approach in ease pain，walking ability, hip function and quality of life，but it should also take into account physical activity and mental health factors. It is suggested to use a variety of scales for comprehensive evaluating the postoperative efficacy.