Primary total hip arthroplasty through direct anterior approach with or without repair of anterior capsule
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[目的]比较直前方关节入路(direct anterior approach,DAA)初次全髋关节置换(total hip arthroplasty,THA)是否缝合前关节囊的临床结果.[方法]2022年1月—2022年7月在本科采用DAA行初次THA的205患者纳入本研究,依据医患沟通结果,将患者分为两组,其中切除组102例,修复组103例.比较两组患者围手术期、随访及影像结果.[结果]两组患者手术时间、切口长度、术中失血量、下地行走时间、切口愈合情况、住院时间的差异均无统计学意义(P＞0.05).所有患者均获随访1年以上,两组患者恢复完全负重时间的差异无统计学意义(P＞0.05).与术前相比,术后1年切除组和修复组患者VAS评分[(6.8±1.1),(0.05±0.2),P＜0.001;(6.6±1.1),(0.04±0.2),P＜0.001]、Harris 评分[(42.7±5.9),(94.7±1.9),P＜0.001;(41.7±6.1),(94.9±1.6),P＜0.001]、髋伸-屈 ROM[(48.1±16.6)°,(122.0±5.4)°,P＜0.001;(47.1±14.7)°,(121.9±4.6)°,P＜0.001]、内-外旋 ROM[(35.7±14.1)°,(81.4±4.2)°,P＜0.001;(32.7±13.9)°,(81.1±5.2)°,P＜0.001]均显著增改善,相应时间点,两组间上述指标的差异均无统计学意义(P＞0.05).两组术后髋臼外展角、髋臼前倾角、双侧股骨长度差及股骨假体位置的差异无统计学意义(P＞0.05).[结论]DAA入路初次THA切除与缝合前关节囊对于患者的临床效果没有影响.对于初学者来说,广泛切除关节囊更有利于髋臼的显露和手术的顺利进行.
[Objective]To compare the clinical results of primary total hip arthroplasty through direct anterior approach with or without repair of anterior capsule.[Methods]From January 2022 to July 2022,a total of 205 patients who underwent primary THA by DAA ap-proach in our department were included in this study.According to doctor-patient communication,102 patients had the anterior capsule re-sected completely,while other 103 patients had the capsule repaired after prosthetic placement.The documents regarding to perioperative period,follow-up and images were compared between the two groups.[Results]There were no significant differences in operation time,inci-sion length,intraoperative blood loss,postoperative walking time,incision healing grade and hospital stay between the two groups(P＞0.05).All patients were followed up for more than 1 year,and there was no statistically significant difference in the time to regain full weight bear-ing between the two groups(P＞0.05).Compared with those preoperatively,the patients in both resection group and the repair group got signif-icant improvements in terms of VAS score[(6.8±1.1),(0.05±0.2),P＜0.001;(6.6±1.1),(0.04±0.2),P＜0.001],Harris score[(42.7±5.9),(94.7±1.9),P＜0.001;(41.7±6.1),(94.9±1.6),P＜0.001],hip flexion-extension ROM[(48.1±16.6)°,(122.0±5.4)°,P＜0.001;(47.1±14.7)°,(121.9±4.6)°,P＜0.001],internal-external rotation ROM[(35.7±14.1)°,(81.4±4.2)°,P＜0.001;(32.7±13.9)°,(81.1±5.2)°,P＜0.001].However,there was no significant difference in the above indexes between the two groups at any corresponding time points(P＞0.05).Radiographically,there were no significant differences in acetabular abduction angle,acetabular anteversion angle,bilateral femoral length difference and femoral prosthetic position between the two groups(P＞0.05).[Conclusion]In primary THA through DAA,anterior capsule resection or repair by su-ture has no remarkable impact on the clinical outcome.For beginners,extensive removal of the capsule is more conducive to expose the ace-tabulum and smooth surgical operation.
total hip arthroplastydirect anterior approachanterior capsuleexcisionsuture
NETL
NSTL
万方数据
