中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (9): 1377-1382.doi: 10.12307/2023.213

• 人工假体 artificial prosthesis • 上一篇    下一篇

改良直接前方入路与直接前方入路初次全髋关节置换者12个月随访结果比较

可雨奇,陈长健,吴  浩,郑连杰   

  1. 大连医科大学第二附属医院,辽宁省大连市   116023
  • 收稿日期:2021-12-01 接受日期:2022-02-09 出版日期:2023-03-28 发布日期:2022-07-01
  • 通讯作者: 陈长健,主治医师,大连医科大学第二附属医院,辽宁省大连市 116023
  • 作者简介:可雨奇,男,1996年生,辽宁省沈阳市人,汉族,在读硕士,主要从事关节外科方面的研究。

Comparison of 12-month follow-up results of primary total hip arthroplasty between modified direct anterior approach and direct anterior approach

Ke Yuqi, Chen Changjian, Wu Hao, Zheng Lianjie   

  1. Second Affiliated Hospital of Dalian Medical University, Dalian 116023, Liaoning Province, China
  • Received:2021-12-01 Accepted:2022-02-09 Online:2023-03-28 Published:2022-07-01
  • Contact: Chen Changjian, Attending physician, Second Affiliated Hospital of Dalian Medical University, Dalian 116023, Liaoning Province, China
  • About author:Ke Yuqi, Master candidate, Second Affiliated Hospital of Dalian Medical University, Dalian 116023, Liaoning Province, China

摘要:

文题释义:
改良直接前方入路全髋关节置换:在传统直接前方入路全髋关节置换手术方法的基础上,将切口向近端垂直向上延伸3 cm左右,阔筋膜张肌的髂骨止点处做适度松解剥离以释放张力。剥离时紧贴髂骨止点处剥离,阔筋膜张肌近端保留韧性组织,便于缝合,松解深度要足够,一般为3-5 cm,深部无韧性组织,深度不够反而使肌肉撕裂,注意血管出血。切开、缝合不要过度偏内,以避免损伤股外侧皮神经。缝合时患肢屈髋45°,减少阔筋膜张肌张力,对合切缘,以鱼骨线由近端向远端做连续缝合,只缝合表面韧性肌腱组织,深层肌腹不做缝合处理。
相关髋部肌肉超声:彩色多普勒超声已被证实在肌肉损伤的诊断上有着较高价值。术前及术后第2天测量并对比相同位置相关肌肉标记点,直观反映了直接前方入路全髋关节置换手术前后髋部相关肌肉厚度变化,间接证明了术中采取松解阔筋膜张肌在髂嵴止点处可以有效减轻肌肉损伤,同时术野更好、手术操作更简便。

背景:直接前路全髋关节置换手术中会导致相关肌肉张力增大,造成挫伤,尤其是对于高体质量指数、体格强壮男性患者的阔筋膜张肌更易受损,进而出现炎症反应及术后早期相关并发症。
目的:探究改良直接前方入路和直接前方入路全髋关节置换的早期疗效差异。
方法:选择2019 年6月至2020年8月大连医科大学附属第二医院收治的68例拟行全髋关节置换患者,按照随机数字表法分为2组,一组采用直接前入路,另一组采用改良直接前入路,每组34例。术前及术后第2天,检测患者血常规、肌酸激酶、C-反应蛋白、血红蛋白水平及髋部相关肌超声厚度值;术后第2天、1个月,评估髋部前屈、外展肌力;术前及术后 2 d、1个月、6个月、12个月,评估患者目测类比评分与髋关节功能Harris评分。
结果与结论:①随访12个月内,68例患者均未发生假体周围感染、假体周围溶骨、假体松动及假体周围骨折;②改良直接前入路组手术前后肌酸激酶变化值、阔筋膜张肌厚度变化值、股外侧肌厚度变化值、股中间肌厚度变化值均小于直接前入路组(P < 0.05),两组术后第2天、1个月的髋部前屈、外展肌力评级比较差异无显著性意义(P > 0.05);③术前及术后 2 d、1个月、6个月、12个月,两组间目测类比评分与髋关节功能Harris评分比较差异均无显著性意义(P > 0.05);其中,改良直接前入路组34例患者中有14例术后出现轻度的髂嵴区疼痛,术后1个月疼痛消失;④结果显示,相对于传统直接前入路全髋关节置换,改良直接前入路全髋关节置换有助于减轻阔筋膜张肌等软组织碾挫损伤,虽然增加了髂嵴痛,但并不影响患者早期疼痛评分及康复功能训练,对于体格强壮、软组织张力大的患者尤为适用。

https://orcid.org/0000-0002-6085-3828 (可雨奇)

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 全髋关节置换, 改良直接前方入路, 直接前方入路, 阔筋膜张肌松解, 肌肉损伤, 术后早期疗效

Abstract: BACKGROUND: Direct anterior total hip arthroplasty can lead to increased muscle tension and contusion, especially in male patients with high body mass index and strong physique. Then, inflammatory reaction and early postoperative complications occurred. 
OBJECTIVE: To explore the difference in early curative effect of modified direct anterior approach and direct anterior approach in total hip arthroplasty. 
METHODS: The clinical data of 68 patients undergoing direct anterior approach for total hip arthroplasty admitted to the Second Affiliated Hospital of Dalian Medical University from June 2019 to August 2020 were collected and randomly divided into the modified group (modified direct anterior approach) and the traditional group (direct anterior approach) (n=34). Blood routine, creatine kinase, C-reactive protein, hemoglobin content and ultrasonic thickness of hip-related muscles were detected before operation and 2 days after operation. The hip flexion and abduction muscle strength were evaluated at 2 days and 1 month after the operation. The visual analogue scale score and Harris score of the hip joint were evaluated preoperatively, 2 days, 1, 6, and 12 months postoperatively. 
RESULTS AND CONCLUSION: (1) Within 12 months of follow-up, no periprosthetic infection, periprosthetic osteolysis, prosthesis loosening or periprosthetic fracture occurred in 68 patients. (2) The changes in creatine kinase, tensor fascia lata thickness, vastus lateralis muscle thickness, and vastus intermedius thickness before and after surgery in the modified direct anterior approach group were all lower than those in the direct anterior approach group (P < 0.05). There was no significant difference in hip flexion and abductor strength ratings at 2 days and 1 month after operation between the two groups (P > 0.05). (3) Before surgery and at 2 days, 1, 6, and 12 months after surgery, there was no significant difference between the two groups in the visual analogue scale score and Harris score of the hip joint (P > 0.05). Among the 34 patients in the direct anterior approach group, 14 patients had mild iliac crest pain after surgery, and the pain disappeared 1 month after surgery. (4) The results conclude that compared with the traditional direct anterior approach, the modified direct anterior approach is helpful to reduce the injury of soft tissue such as tensor fascia lata. Although the iliac crest pain is increased, it does not affect the early pain score and rehabilitation function training of patients. The modified approach is especially suitable for patients with strong physique and high soft tissue tension. 

Key words: total hip arthroplasty, modified direct anterior approach, direct anterior approach, tensor fascia lata release, muscle damage, early postoperative efficacy

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