| 季卫锋,董玉鹏,尚美妍,等.“筋骨并重”理论指导下微创直接前方入路全髋关节置换术[J].浙江中医药大学学报,2019,43(6):533-539. |
| “筋骨并重”理论指导下微创直接前方入路全髋关节置换术 |
| Clinical Efficacy Study of the Direct Anterior Approach for Minimally Invasive Total Hip Arthroplasty with the Guidance of the Theory of “Muscle and Bone are Both Important” |
| DOI：10.16466/j.issn1005-5509.2019.06.003 |
| 中文关键词: 筋骨并重 关节置换 髋 直接前方入路 后侧入路 中医骨伤 |
| 英文关键词: muscle and bone are both important arthroplasty hip direct anterior approach posterior lateral approach TCM orthopedics |
| 基金项目:中国博士后科学基金(2015M571245) |
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| 中文摘要: |
| [目的]探讨基于“筋骨并重”理论的微创直接前方入路(direct anterior approach，DAA)全髋关节置换术的临床疗效。[方法]回顾性分析2013年1月至2016年10月108例于浙江中医药大学附属第一医院行全髋关节置换术的患者资料，根据手术入路方式的不同分为2组，其中DAA组46例，在“筋骨并重”理论指导下，采用微创DAA全髋关节置换术；传统后侧入路组62例，采用传统后侧入路全髋关节置换术。比较两组患者的切口长度、手术时间、术中出血量、术后引流量、术中术后假体角度、术后首次下地时间、术后住院时间，术后各阶段髋关节Harris评分、并发症等。[结果]所有患者术后均获得随访，随访时间24～27个月，平均(25.5±3.2)个月。DAA组患者的切口长度、术中出血量、术后引流量均少于传统后侧入路组，患者术后首次下地时间早于传统后测入路组，术后住院时间短于传统后测入路组，差异均有统计学意义(P＜0.01)，两组手术时间无统计学差异(P=0.081)。DAA组术中、术后髋臼前倾角、外展角对比无统计学差异(P=0.443，P=0.457)；传统后侧入路术中、术后髋臼前倾角、外展角对比差异有统计学意义(P＜0.05)。DAA组患者术后1周、1个月、3个月Harris评分优于传统后侧入路组，差异均具有统计学意义(P＜0.01)，两组患者术后6个月、1年、2年Harris评分对比差异无统计学意义(P＞0.05)。[结论]基于中医“筋骨并重”理论指导，微创DAA全髋关节置换术相较于传统后侧入路术式，能够避免对关节周围“筋”的损伤，具有减少软组织损伤和加快术后康复的优势，但远期康复疗效相同。 |
| 英文摘要: |
| [Objective] To explore the clinical effects of the direct anterior approach(DAA) for minimally invasive total hip arthroplasty(THA) with the guidance of the theory of“muscle and bone are both important”. [Methods] One hundred and eight patients treated with THA from January 2013 to October 2016 were retrospective analyzed. The patients were divided into two groups according to the way of surgical approach，46 patients in DAA group was treated by DAA operation with the guidance of the theory of“muscle and bone are both important”; 62 patients in the posterior lateral approach group was treated by posterior lateral approach operation. The incision length, operation time, intraoperative blood loss, postoperative flow, prosthesis angle, the first walk after the operation, postoperative hospital stays, Harris hip performance score at different times and complications were compared between two groups. [Results] All patients were followed up for 24 to 27 months, average(25.5±3.2) months，The incision length, intraoperative blood loss, postoperative flow, the first walk after the operation, postoperative hospital stays, were shorter in DAA group compared with posterior lateral approach group(P＜0.01)，there was no significant difference in operation time between the two groups(P=0.081).There were no significant differences in abduction angle and anteversion angle in DAA group between intra-operative and postoperative(P=0.443，P=0.457); while there were significant differences in posterior lateral approach group between intra-operative and postoperative(P＜0.05). Harris hip performance score of one week，one month and three months after surgery were superior in DAA group compared with posterior lateral approach group(P＜0.01). There was no statistical difference in six month, one year and two years after surgery between the two groups(P＞0.05). [Conclusion] With the guidance of the theory of “muscle and bone are both important”, the DAA for minimally invasive THA through the real muscle gap entry, avoiding the damage of the " muscle " around the joints, has the advantage of reducing soft tissue damage, accurate placement of the acetabular prosthesis and accelerating postoperative rehabilitation compared with the posterior lateral approach, but the long-term effects of the two are the same. |
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