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-  2018 

前侧入路和后外侧入路人工全髋关节置换术后假体位置的影像学比较 A Comparison of Radiographic Outcomes After Total Hip Arthroplasty Between the Posterolateral Approach and Direct Anterior Approach

Keywords: 全髋关节置换,直接前侧入路,外展角,前倾角,肢体长度差异,股骨偏心距

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Abstract:

目的:分析比较直接前侧入路与后外侧入路在人工全髋关节置换术后假体位置的差异,并与Lewinnek等人描述的安全范围比较,评估使用两种手术方法安放髋臼假体的准确性。方法:回顾性分析2016年4月至2017年6月我科的90例人工全髋关节置换病例,其中45例采用直接前侧入路(DAA),45例采用后外侧入路(PLA)。所有病例均为单侧全髋关节初次置换,股骨近端严重畸形、髋臼后方缺损、僵直髋、以及CrownⅢ/Ⅳ型髋关节发育不良以及需要使用特殊假体的病例均被排除。手术由熟悉两种术式的同一医师完成。术后摄取X线片,利用计算机软件测量髋臼假体安放时外展角、前倾角、肢体长度差异及股骨偏心距差异,从而评价假体位置。结果:直接前侧入路组和后外侧组的外展角、前倾角、肢体长度差异及股骨偏心距差异分别为(41.97±6.36)°和(35.58±5.12)°,(16.38±4.75)°和(13.49±3.9)°,(4.1±1.25)mm和(3.9±1.1)mm,(3.7±0.9)mm和(4.2±1.1)mm。其中,两组入路臼杯外展角对比,直接前侧入路组大于后外侧入路(P<0.05),两组入路臼杯前倾角、肢体长度差异及股骨偏心距差异对比无差异(P>0.05);上述各指标在安全范围内视为可接受,可接受率分别为93.33%和77.78%,86.67%和91.11%,86.67%和88.89%,84.44%和86.67%,其中,两组入路臼杯外展角可接受率对比,直接前侧入路组大于后外侧入路(P<0.05),两组入路臼杯前倾角、肢体长度差异及股骨偏心距差异对比无差异(P>0.05)。结论:直接前侧入路相比后外侧入路,臼杯外展角较大,且具有更高可接受率;两组入路臼杯前倾角、肢体长度差异及股骨偏心距无明显差异

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