|
|
|
| Comparison of Clinical Effect and VAS Score between Direct Anterior Approach and Posterolateral Approach in Supine Position in Total Hip Replacement |
| TENG Lichu, CHEN Tuo, HUANG Shen, et al |
| The People's Hospital of Wuzhou, Guangxi Wuzhou 543000, China |
|
|
|
|
Abstract Objective: To explore the clinical effect of direct anterior approach and posterolateral approach in supine position in total hip replacement and the change of VAS score. Methods: From January 2017 to December 2019, 80 patients with osteonecrosis of the femoral head in our hospital were selected. All patients underwent total hip arthroplasty. They were simply random divided into front approach group and posterolateral approach group with 40 cases each. The front approach group adopted the direct anterior approach in a prone position, and the posterolateral approach group adopted the posterolateral approach. The clinical effects of the two groups were compared and the patients in the two groups were observed The changes of VAS score, Harris score, Barthel Index and inflammatory factor level were compared before and after the operation, and the incidence of complications was compared between the two groups. Results: There was no significant difference between the two groups (χ2= 0.538, P=0.764). The amount of bleeding, the length of incision, the time of descent and the time of hospitalization in the anterior approach group were less than those in the posterolateral approach group, and the operation time was more than those in the posterolateral approach group, the difference was statistically significant (P<0.05). The VAS score of the anterior approach group was significantly lower than that of the posterolateral approach group at 24 hours, 72 hours and 1 month postoperatively (P<0.05), but there was no significant difference between the two groups at 6 months postoperatively (P>0.05). Before the operation, there was no significant difference in Harris score and Barthel index between the anterior approach group and the posterolateral approach group (P>0.05); after the operation, the Harris score and Barthel index of the two groups were all increased, and the degree of increase in the anterior approach group was more significant, the difference was statistically significant (P<0.05). There was no significant difference in the level of inflammatory factors between the two groups (P>0.05); the levels of IL-1, IL-6 and TNF-α in the two groups decreased 24 hours after operation, and the levels of IL-1, IL-6 and TNF-α in the front approach group were lower than those in the rear lateral approach group (P<0.05). There were 3 adverse reactions in the anterior approach group and 12 in the posterolateral approach group. The incidence of complications in the anterior approach group (7.50%) was significantly lower than that in the posterolateral approach group (30.00%) (χ2=6.646, P=0.036). Conclusion: In total hip replacement, compared with posterolateral approach, direct anterior approach can shorten the operation time and intraoperative bleeding, relieve patients' pain, improve the function of hip joint, reduce patients' inflammatory reaction, and have fewer postoperative complications, which is worthy of further clinical promotion.
|
|
|
|
|
|
[1] 殷振华,董辉辉,陈轲,等.人工全髋关节置换术和股骨头置换术治疗老年股骨颈骨折临床疗效分析[J].河北医学,2016,22(7):1095~1098.
[2] 刘先哲,杨述华.早期年轻股骨头坏死保髋治疗常用方法及效果[J].临床外科杂志,2017,25(8):576~579.
[3] Connolly K P,Kamath A F. Direct anterior total hip arthroplasty:literature review of variations in surgical technique[J].World Orthop,2016,7(1):38~43.
[4] Hara D,Hamai S,Komiyama K,et al.Sports participation in patients after total hip arthroplasty vs periacetabular osteotomy:a propensity score-matched asian cohort study[J].Arthroplasty,2018,33(2):423~430.
[5] 张洋,季卫锋,钱秀娟,等.支架辅助下前入路全髋关节置换术治疗老年患者股骨颈骨折22例[J].中国中医骨伤科杂志,2019,27(6):76~78.
[6] 田晋,颜斌.不同手术入路对髋关节置换术后髋关节功能恢复的影响[J].中国伤残医学,2016,24(10):59~60.
[7] Gofton W, Fitch DA. In-hospital cost comparison between the standard lateral and supercapsular percutaneously-assisted total hip surgical techniques for total hip replacement[J].International Ortho paedics,2016,40(3):481.
[8] 傅兰清.前外侧微创入路行全髋关节置换术治疗老年股骨颈骨折的疗效及安全性分析[J].武警后勤学院学报(医学版),2017,26(5):439~441.
[9] 徐亦鹏,孙绍婷,王佳佳,等.不同手术入路行初次人工全髋关节置换术的近期疗效比较[J].中国修复重建外科杂志,2017,31(04):397~403. |
|
|
|
2020, Vol. 26 
