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Title: [Short-term effectiveness of minimally invasive total hip arthroplasty by direct anterior approach].
Author: Zhao M, Hu Y, Zeng M, Zhong D, Xie J.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2017 Jan 15; 31(1):11-16. PubMed ID: 29798622.
Abstract:
OBJECTIVE: To evaluate the short-term effectiveness of minimally invasive total hip arthroplasty (THA) by direct anterior approach (DAA). METHODS: Between January and August 2014, THA was performed on 48 patients (60 hips) by DAA (group A), and on 72 patients (92 hips) by posterolateral approach (group B). There was no significant difference in gender, age, etiology, course, and preoperative visual analogue scale (VAS), Harris hip score (HHS), and hip range of motion (ROM) between 2 groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospitalization time, incision healing, and complications were recorded and compared. The acetabular abduction and anteversion were measured on the X-ray films; prosthesis loosening was observed. The VAS score, HHS score, and hip ROM were used to evaluate the hip function. RESULTS: The operation time and intraoperative blood loss of group A were significantly higher than those of group B, and the hospitalization time was significantly lower than group B ( P<0.05), but no significant difference was found in postoperative drainage between 2 groups ( t=0.71, P=0.46). The patients were followed up 2-2.5 years (mean, 2.2 years) in group A, and 2-2.5 years (mean, 2.1 years) in group B. In group A, 3 cases had lateral femoral cutaneous nerve traction injury and 1 case had swelling and exudate, and primary healing of incision was obtained in the other cases of group A and all cases of group B. No periprosthetic joint infection occurred in the others of groups A and B except 1 case of group A at 2 months after operation, and infection was controlled after debridement, irrigation, and intravenous infusion of Vancomycin for 1 month. The X-ray films showed good position of prosthesis and no obvious radiolucent line or prosthesis loosening. There was no significant differences in acetabular abduction and anteversion between groups A and B at last follow-up ( P>0.05). The VAS score, HHS score, and hip ROM at 3 months and last follow-up were significantly better than preoperative ones in 2 groups ( P<0.05), but no significant difference was found between at 3 months and last follow-up ( P>0.05). The VAS score, HHS score, and hip ROM in group A were significantly better than those in group B at 3 months postoperatively ( P<0.05). At last follow-up, the hip ROM in group A was significantly better than that in group B ( P<0.05), and there was no significant difference in VAS and HHS scores between group A and group B ( P>0.05). CONCLUSION: The short-term effectiveness of minimally invasive THA by DAA is satisfactory, with the advantage of little trauma, short hospital stay, and rapid postoperative recovery. 目的: 探讨采用前路微创入路髋关节置换术的早期疗效。. 方法: 回顾分析 2014 年 1 月—8 月采用前侧微创入路髋关节置换术治疗的 48 例（60 髋）患者临床资料（A 组），并与同期采用后外侧入路髋关节置换术的 72 例（92 髋）患者（B 组）进行比较。两组患者性别、年龄、病因、病程及术前疼痛视觉模拟评分（VAS）、Harris 评分系统（Harris hip score，HHS）、髋关节屈伸活动度等一般资料比较差异无统计学意义（ P>0.05），具有可比性。记录并比较两组患者手术时间、术中出血量、术后引流量、住院时间、切口愈合及并发症发生情况。术后根据 X 线片测量髋关节假体髋臼外展角、前倾角，并评价是否存在假体松动等迹象；采用 VAS、HHS 评分及髋关节屈伸活动度评价髋关节功能。. 结果: A 组患者手术时间、术中出血量显著高于 B 组，住院时间少于 B 组（ P<0.05）；两组术后引流量比较差异无统计学意义（ t=0.71， P=0.46）。两组患者均获随访，A 组随访时间 2～2.5 年，平均 2.2 年；B 组随访时间 2～2.5 年，平均 2.1 年。A 组 3 例患者出现股外侧皮神经牵拉损伤，1 例术后出现切口红肿渗液，其余伤口均Ⅰ期愈合；B 组未出现神经损伤，所有伤口Ⅰ期愈合。A 组 1 例患者于术后 2 个月出现假体周围感染，予以早期清创灌洗+万古霉素抗感染治疗 1 个月后感染逐渐控制；B组未见假体周围感染发生。复查 X 线片示两组假体位置均良好，假体周围无明显透亮带，未见明显假体松动迹象发生。末次随访时两组髋臼外展角及髋臼前倾角比较差异均无统计学意义（ P>0.05）。A、B 组术后 3 个月及末次随访时的VAS、HHS评分及髋关节屈伸活动度均显著优于术前（ P<0.05）；末次随访时与术后 3 个月比较差异无统计学意义（ P>0.05）。术后 3 个月 A 组各指标均显著优于 B 组（ P<0.05）；末次随访时 A 组髋关节屈伸活动度显著优于 B 组（ P<0.05），但两组 VAS、HHS 评分比较差异无统计学意义（ P>0.05）。. 结论: 前侧微创入路髋关节置换术的早期疗效优良，具有创伤小、住院时间短、恢复快等优势。.

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