黄可 谢克恭 石宇 卢贤哲 陈金忠 陆潞 刘佳 陆敏安 潘生才 唐毓金

【摘要】 目的 探討Supercapsular Percutanously-Assisted Total Hip（SuperPATH）入路和直接外侧入路（direct lateral approach， DLA）两种手术入路方式在初次人工全髋关节置换（total hip arthroplasty，THA）术后早期临床疗效。

方法 将2020年1月至12月在右江民族医学院附属医院行THA治疗的95例股骨头坏死患者和34例股骨颈骨折患者，采用随机分组法分为SuperPATH和DLA两种不同手术入路方式进行治疗。分别比较每个病例组中两种手术入路方式的患者间切口长度、手术时间、术中出血量、术后首次下地时间、术后住院时间、手术前后Hb差值和SAB差值，并采用视觉模拟评分（VAS评分）评价患者术后疼痛程度，髋关节功能Harris评分评价髋关节功能。

结果 两个病例组中使用SuperPATH入路手术切口长度、术中出血量、术后首次下地活动时间、术后住院时间以及手术前后Hb差值和SAB差值均少于DLA入路（P<0.001）;但在手术时间上，股骨头坏死组SuperPATH入路较DLA入路偏长（P<0.05），股骨颈骨折组中两种入路无统计学意义（P>0.05）。两个病例组在术后24 h、1 W、2 W，SuperPATH入路VAS评分较DLA入路低（P<0.001），Harris评分在术后1 W、2 W，SuperPATH入路均优于DLA入路（P<0.001）。

结论 SuperPATH入路THA较DLA入路THA具有更优的早期临床效果，对改善术后围手术期状况和早期关节功能有更好的作用。

【关键词】 人工全髋关节置换术;SuperPATH入路;外侧入路;股骨头坏死;股骨颈骨折

中图分类号：R687.4   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.09.002

Analysis of early clinical efficacy of SuperPATH approach and lateral approach for initial total hip arthroplasty

HUANG Ke， XIE Kegong， SHI Yu， LU Xianzhe， CHEN Jinzhong，

LU Lu， LIU Jia， LU Min'an， PAN Shengcai， TANG Yujin

（Department of Spine Osteopathy and Joint Surgery， Affiliated Hospital of Youjiang Medical University for Nationalities， Baise 533000， Guangxi， China）

【Abstract】 Objective To explore the early clinical efficacy of Supercapsular Percutanously-Assisted Total Hip （SuperPATH） approach and direct lateral approach （DLA） after initial total hip arthroplasty （THA）.

Methods From January to December 2020， 95 patients with femoral head necrosis and 34 patients with femoral neck fracture who underwent THA treatment in our hospital were randomly divided into two different surgical approaches （SuperPATH and DLA） for surgical treatment. And then， incision length， operation time， intraoperative blood loss， start time of out-of-bed activity， postoperative hospital stay， Hb D-value and SAB D-value before and after the operation were compared between the two surgical approaches in each case group. And visual analogue scale （VAS） was used to evaluate the degree of postoperative pain， and Harris score was used to evaluate hip function.

Results In the two case groups，  incision length， intraoperative blood loss， start time of out-of-bed activity， postoperative hospital stay， and Hb D-value and SAB D-value before and after operation of the SuperPATH approach were less than those of the DLA approach （P < 0.001）; while the operation time of the SuperPATH approach in the femoral head necrosis group was longer than that of the DLA approach （P < 0.05）， and there was no statistically significant difference between the two approaches in the femoral neck fracture group （P > 0.05）. Among two case groups， the VAS scores of SuperPATH approach were lower than those of DLA approach at 24 h， 1 W and 2 W after operation （P < 0.001）， and the Harris scores of SuperPATH approach were better than those of DLA approach at 1 W and 2 W after operation （P < 0.001）.

Conclusion THA through SuperPATH approach has better early clinical effect than  through DLA approach， which plays a better role in improving postoperative perioperative condition and early joint function.

【Key words】 THA; SuperpPATH approach; lateral approach; femoral head necrosis; femoral neck fracture

人工全髋关节置换（total hip arthroplasty，THA）是目前治疗髋关节疾病的重要方法之一。THA既可以解决患者髋关节疾病导致的疼痛症状，也可以显著改善病患髋关节的运动功能、矫正髋部畸形。传统的人工髋关节手术入路包括直接外侧入路（direct lateral approach， DLA）、后侧入路（posterior approach， PA）。DLA虽然能够更好地暴露髋臼和股骨近端结构，但是由于该手术入路对于阔筋膜张肌、臀中肌和臀小肌等髋关节外展肌的损伤使得髋部外展功能恢复相对较差[1]。……