后外侧入路与直接前入路全髋关节置换术治疗股骨头坏死的效果及对创伤反应的影响

Effect of posterior lateral approach and direct anterior approach total hip arthroplasty for treatment of femoral head necrosis and its impact on trauma response

摘要:

目的 对股骨头坏死后患者实施外侧入路与直接前入路全髋关节置换术，对其效果及创伤反应进行分析。方法 选取2020年4月至2023年4月河南省洛阳正骨医院收治的股骨头坏死行全髋关节置换术的60例患者，随机分两组，各30例，分别采用后外侧入路全髋关节置换术、直接前入路全髋关节置换术，比较分析两组手术治疗情况。结果 直接前入路组切口长度较后外侧入路组短，术中出血量、术后引流量较后外侧入路组少，术后引流时间、住院时间较后外侧入路组短（P<0.05）；术后1 d直接前入路组的C反应蛋白（CRP）、血沉水平低于后外侧入路组（P<0.05）；术后1个月、3个月及6个月直接前入路组的视觉模拟评分法（VAS）评分低于后外侧入路组，髋关节功能（Harris）评分较后外侧入路组高（P<0.05）；两组术后并发症发生率比较差异无统计学意义（P>0.05）。结论 全髋关节置换术采取两种入路方式治疗股骨头坏死均安全有效，但直接前入路方式能减小创伤，缩短恢复时间，减轻创伤反应，促进功能恢复，值得推广。

Abstract:

Objective To explore and analyze the effectiveness of total hip arthroplasty through the posterior lateral approach and direct anterior approach in the treatment of femoral head necrosis and its impact on trauma response.Methods From April 2020 to April 2023, 60 patients with femoral head necrosis who underwent total hip arthroplasty in Luoyang Orthopedic-Traumatological Hospital of Henan Province were randomly divided into two groups: the posterior lateral approach group and the direct approach group, with 30 cases each. The surgical treatment status of the two groups was compared and analyzed.Results The incision length of the direct anterior approach group was shorter than that of the posterior lateral approach group, with less intraoperative bleeding and postoperative drainage volume. The postoperative drainage time and hospitalization time of the direct anterior approach group were shorter than those of the posterior lateral approach group (P<0.05). The C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels in the direct anterior approach group were lower than those in the posterior lateral approach group 1 day after surgery (P<0.05). At 1 month, 3 months, and 6 months after surgery, the Visual Analogue Scale (VAS) score of the direct anterior approach group was lower than that of the posterior lateral approach group, and the hip joint function (Harris) score was higher than that of the posterior lateral approach group (P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05).Conclusion Total hip arthroplasty using two different approaches for the treatment of femoral head necrosis is safe and effective. However, the direct anterior approach can reduce trauma, shorten recovery time, reduce trauma reactions, and promote functional recovery, which is worth promoting.