Early clinical outcomes of total hip arthroplasty with minimally invasive direct anterior approach and traditional posterolateral approache for femoral head avascular necrosis
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摘要:
目的 对比分析微创前方入路与传统外侧入路人工全髋关节置换术治疗股骨头缺血性坏死的早期临床疗效。 方法 回顾性分析2020年1月—2021年12月钦州宝顺医院骨科收治的60例股骨头缺血性坏死患者资料，其中30例患者行微创前方入路人工全髋关节置换术(A组)，30例患者行传统外侧入路人工全髋关节置换术(B组)。收集整理60例患者的随访资料，对比分析2组手术时间、术中出血量、住院时间、髋关节Harris评分、患者满意度和术后并发症等指标。 结果 60例患者平均随访12个月，2组术中出血量[(200.8±5.6)mL vs. (401.2±10.4)mL]、住院时间[(6.5±1.1)d vs. (10.6±1.2) d]和术后1个月髋关节Harris评分[(90.0±3.3)分vs. (84.4±2.8)分]比较，差异均有统计学意义(P < 0.05)。术后6个月随访时，A组患者的总体满意度高于B组[(98.5±1.3)% vs. (95.2±1.9)%, P < 0.01]，A组患者的疤痕量表评分低于B组[(1.5±0.8)分vs. (3.2±1.0)分, P < 0.01]。 结论 微创前方入路和传统外侧入路人工全髋关节置换术均为治疗股骨头缺血性坏死的有效方法，但微创前方入路可明显减少术中出血和术后疼痛、缩短住院时间，且术后恢复更快、满意度更高。 Abstract:Objective To compare the early clinical efficacy of total hip arthroplasty with minimally invasive direct anterior approach and traditional lateral approach for the treatment of avascular necrosis of the femoral head. Methods A retrospective study was conducted at Baoshun Hospital of Qinzhou from January 2020 to December 2021, involving 60 patients with avascular necrosis of the femoral head. Among them, 30 patients underwent total hip arthroplasty using the minimally invasive direct anterior approach, while the remaining 30 patients underwent the traditional lateral approach. The data of the two groups were collected to compare various factors, including operation time, bleeding volume, hospitalization time, Harris score of the hip joint, patient satisfaction, and postoperative complications. Results The average follow-up period for the 60 patients was 12 months. Statistically significant differences were observed between the two groups in terms of mean intraoperative blood loss [(200.8±5.6)mL vs. (401.2±10.4)mL], length of hospital stay [(6.5±1.1)d vs. (10.6±1.2) d], and Harris score [(90.0±3.3) points vs. (84.4±2.8) points] at 1 month post-operation (P < 0.05). At the 6 month follow-up, the overall satisfaction level in group A was higher than that in group B [(98.5±1.3)% vs. (95.2±1.9)%, P < 0.01] and the scar scale score in group A was lower than that in group B [(1.5±0.8) points vs. (3.2±1.0) points, P < 0.01]. Conclusion Both the minimally invasive direct anterior approach and the posterolateral approach have demonstrated efficacy in treating avascular necrosis of femoral head. However, the minimally invasive direct anterior approach offers distinct advantages, including significantly reduced postoperative pain, decreased intraoperative bleeding, shorter hospital stays, and higher patients satisfaction levels. -
图 1 典型病例的切口设计、影像资料、疤痕愈合情况
注：A为体表的比基尼切口设计图；B为术中的比基尼切口和微创前方入路；C为术前DR提示双侧股骨头坏死；D为术后复查的骨盆正位片；E为比基尼切口愈合后的疤痕(小)；F为外侧入路切口愈合后的疤痕(大)。
Figure 1. Incision design, imaging data and scar healing of typical cases
表 1 2组行THA的ANFH患者一般资料比较
Table 1. The general data of ANFH patients undergoing THA were compared between the two groups
组别 例数 性别(男性/女性，例) 年龄(x±s，岁) BMI(x±s) 患髋(左/右，例) 股骨头坏死(双侧/单侧，例) A组 30 18/12 65.13±6.02 21.60±1.40 13/17 3/27 B组 30 19/11 66.10±3.01 21.50±1.57 14/16 2/28 统计量 0.071 0.706 0.830 0.067 < 0.001 P值 0.791 0.435 0.796 0.795 0.999 注：a为χ2值，b为t值。 
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表 2 2组ANFH患者手术时间、出血量、住院时间和Harris评分比较(x±s)
Table 2. The operation time, blood loss, hospital stay and Harris score were compared between the two groups of ANFH patients(x±s)
组别 例数 手术时间(min) 术中出血量(mL) 住院时间(d) Harris评分(分) 术后1个月 术后6个月 A组 30 92.9±3.5 200.8±5.6 6.5±1.1 90.0±3.3 95.4±1.5 B组 30 91.2±2.9 401.2±10.4 10.6±1.2 84.4±2.8 94.7±2.1 t值 1.928 92.947 13.699 7.113 1.591 P值 0.059 < 0.001 < 0.001 < 0.001 0.117
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表 3 2组ANFH患者术后并发症发生情况(例)
Table 3. Postoperative complications of ANFH patients in two groups (case)
组别 例数 脱位 骨折 感染 神经损伤 腿长差异＞1 cm A组 30 0 0 0 2 0 B组 30 1 1 0 0 2
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表 4 2组ANFH患者满意度和Vancouver疤痕量表评分比较
Table 4. Comparison of ANFH patient satisfaction and Vancouver Scar Scale scores between the two groups
组别 例数 总体满意得分(x±s，分) 疤痕满意(例) Vancouver疤痕量表(x±s，分) 术后1个月 术后6个月 满意 不满意 术后1个月 术后6个月 A组 30 89.6±2.2 98.5±1.3 30 0 7.5±2.1 1.5±0.8 B组 30 80.4±2.7 95.2±1.9 25 5 7.8±1.9 3.2±1.0 统计量 14.738a 7.743a 3.491b 0.654a 7.268a P值 < 0.001 < 0.001 0.062 0.516 < 0.001 注：a为t值，b为χ2值。
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