侧卧位直接上方入路在股骨头缺血性坏死患者全髋关节置换术中的应用OA
Application of the Direct Superior Approach in the Lateral Position in Total Hip Arthroplasty for Patients with Avascular Necrosis of the Femoral Head
目的 探讨侧卧位直接上方入路在股骨头缺血性坏死患者全髋关节置换术中的应用效果.方法 回顾性选取2020年3月至2025年5月九〇三医院收治的132例行全髋关节置换术的股骨头缺血性坏死患者为研究对象,根据手术入路方式不同分为观察组(68例)和对照组(64例).观察组采取侧卧位直接上方入路,对照组采取传统后外侧入路.比较两组围手术期指标、炎症应激因子[C反应蛋白(CRP)、红细胞沉降率、白细胞介素6(IL-6)]水平、Harris髋关节功能评分(HHS)及并发症总发生率.结果 观察组术中出血量少于对照组(P<0.05),手术时间、切口长度、住院时间及术后下床活动时间均短于对照组(P<0.05).术后1周,两组CRP、红细胞沉降率、IL-6水平均低于术前(P<0.05),且观察组CRP、红细胞沉降率、IL-6水平均低于对照组(P<0.05).术后3个月,两组HHS各维度评分均高于同组术前(P<0.05),但两组组间各维度评分比较,差异均无统计学意义(P>0.05).观察组和对照组并发症总发生率分别为4.41%、15.63%,观察组低于对照组(P<0.05).结论 侧卧位直接上方入路应用于股骨头缺血性坏死患者全髋关节置换术中,可有效优化围手术期指标,减轻手术应激反应,降低并发症发生风险,且能达到与传统后外侧入路相当的髋关节功能恢复效果,是一种安全、高效的手术入路选择.
Objective To investigate the clinical application effect of the direct superior approach in the lateral position in total hip arthroplasty for patients with avascular necrosis of the femoral head.Methods A retrospective analysis was conducted on 132 patients with avascular necrosis of the femoral head who underwent total hip arthroplasty in the 903 Hospital between March 2020 and May 2025.According to different surgical approaches,the patients were divided into an observation group(n=68,treated with the direct superior approach in the lateral position)and a control group(n=64,treated with the traditional posterolateral approach).Perioperative indicators,levels of inflammatory stress factors[C-reactive protein(CRP),erythrocyte sedimentation rate,interleukin-6(IL-6)],Harris Hip Score(HHS),and the overall incidence of complications were compared between the two groups.Results The observation group had less intraoperative blood loss than the control group(P<0.05),and shorter operative time,incision length,hospital stay,and postoperative time to ambulation than the control group(P<0.05).At one week after surgery,the levels of CRP,erythrocyte sedimentation rate,and IL-6 in both groups were lower than those before surgery(P<0.05),and the levels in the observation group were lower than those in the control group(P<0.05).At three months after surgery,the HHS scores in all dimensions were higher in both groups than before surgery(P<0.05),but no statistically significant difference was found between the two groups in any dimension(P>0.05).The overall incidence of complications in the observation group and the control group was 4.41％and 15.63％,respectively,with the observation group showing a significantly lower rate(P<0.05).Conclusion The application of the direct superior approach in the lateral position in total hip arthroplasty for patients with avascular necrosis of the femoral head can effectively optimize perioperative indicators,alleviate surgical stress response,and reduce the risk of complications,while achieving hip function recovery comparable to that of the traditional posterolateral approach.It is a safe and efficient surgical approach.
刘宝应;吴凯;李哲;赵洪宝;冯平;阳明刚
九〇三医院骨科,四川江油 621700九〇三医院骨科,四川江油 621700九〇三医院骨科,四川江油 621700九〇三医院骨科,四川江油 621700九〇三医院骨科,四川江油 621700九〇三医院骨科,四川江油 621700
股骨头缺血性坏死全髋关节置换术侧卧位直接上方入路
avascular necrosis of the femoral headtotal hip arthroplastylateral positiondirect superior approach
《转化医学杂志》 2026 (8)
1296-1300,5
2025年度四川省医学会骨科专项科研项目(2025SAT18)
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