| Background:At present,total hip arthropasty(THA)is the surgical method used to treat most hip diseases,in which artificial prosthesis is used to repace the hip joint of the human body,so as to reproduce the function of the human hip joint.There are many surgical approaches in this operation.With the discovery and exploration of several generations,the surgical trauma is decreasing and the success rate of the operation is increasing.At present,posterolateral approach(PLA)is the most widely used approach,which is fully exposed,but has some shortcomings.If the short external rotator muscle group of the hip is cut off,the risk of posterolateral dislocation of the hip is higher.The other approach,direct anterior approach(DAA),enters the hip joint from the muscle gap without causing loss of the surrounding muscles of the hip joint.As a result,the dislocation rate of the hip joint has been greatly reduced.At present,DAA is more and more widely used in clinic.Objective:The changes of serum biology and imaging characteristics and clinical significance of patients with THA after DAA and PLA approaches were analyzed,and the perihip muscle injury and clinical significance of the two approaches were discussed.Method:We collected 84 cases of total hip arthropasty in Shanghai General Hospital from June 2017 to December 2018.Among them,39 cases underwent direct anterior approach and 45 cases underwent posterolateral approach.All patients underwent unilateral total hip arthropasty.The operation time,intraoperative blood loss,incision length,anteversion and abduction angle of acetabular prosthesis,Harris score before and after operation were counted.The expression levels of CRP,IL-6 and CK in fasting venous blood were monitored at the same time point in the morning of 1 day before operation,1,3 and 5 days after operation.CT and MRI were analyzed before and 7 days,1 month and 6 months after operation.The maximum abdominal width of intraobturator,piriformis and extraobturator muscles of hip joint were analyzed before and after operation,so as to understand the degree of muscle damage around hip joint.Results:By comparing the installation angle,operation time,intraoperative blood loss,incision length,serological index,imaging index and postoperative rehabilitation of hip prosthesis in patients with DAA and PLA approaches,it was concluded that:1.The comparison of the angle of prosthesis installation shows that there are no differences in the acetabular abduction angle,anteversion angle,femoral prosthesis rotation angle and compression degree.2.Comparisons of operative time,intraoperative blood loss and incision length: The operation time,intraoperative bleeding volume and incision length in DAA group were 74.9(+12.4)min,211.8(+19.4 ml),10.26(+2.14 cm),respectively.The operation time,intraoperative bleeding volume and incision length in PLA group were 61.7(+8.8 min),272.7(+21.2 ml)and 12.41(+3.24 cm),respectively.The time is prolonged.After installing acetabular cup in total hip arthropasty through DAA approach,the patient’s position should be adjusted to overextend the lower limbs to facilitate the operation of the femoral side.At the same time,the proximal femur needs to be released,resulting in prolonged operation time.But after mastering the DAA approach,timely treatment of lateral circumflex femoral artery can reduce the amount of bleeding and operation time.3.Comparison of serological indexes before and after operation between the two groups:The preoperative serological parameters(CRP,IL-6,CK)of the two groups were basically the same.The levels of serum inflammatory factors in the DAA group were significantly lower than those in the PLA group,which indicated that DAA approach could better protect the muscles around the hip joint and alleviate the injury.4.Imaging comparison:By comparing the maximum abdominal width of obturator muscles scanned by CT before and 7 days,1 month and 6 months after operation between DAA group and PLA group,the degree of muscle atrophy in DAA group was significantly smaller than that in PLA group.There were significant differences in the interaction between groups(F=3.495,P=0.042),at different time points(F=20.782,P=0.000),between groups and at different time points(F=6.897,P=0.032)(P<0.05).。 By comparing the width of the piriformis muscle scanned by two groups,there were significant differences in the interaction between groups(F = 2.966,P = 0.022),at different time points(F = 22.791,P = 0.000),between groups and at different time points(F = 5.773,P = 0.041)(P < 0.05).By comparing the width of the external obturator muscle scanned by two groups,there were significant differences in the interaction between groups(F = 3.493,P = 0.035),at different time points(F = 21.754,P = 0.000),between groups and at different time points(F = 2.694,P = 0.021)(P < 0.05).The results showed that DAA group had more advantages in protecting the muscles around the hip joint and effectively protected the soft tissue around the hip joint.5.Postoperative rehabilitation comparison: With the progress of the course of disease,the VAS scores of PLA group and DAA group decreased gradually.The VAS scores of DAA group were lower than that of PLA group.Data analysis was made between the two groups,at different time points of the two groups,and at different time points of the two groups.The difference was statistically significant(P<0.05),as shown in Table 9.As the course of disease progressed,the Harris hip function score of the two groups increased gradually.Overall,DAA group was higher than PLA group.The hip function of DAA group was better than PLA group(F = 3.781,P = 0.033),different time points(F = 26.659,P = 0.000)and different time points(F = 8.955,P = 0.011)between the two groups had statistical significance(P < 0.05).The excellent and good rate of hip function in group A was significantly higher than that in group PLA(P < 0.05).Conclusion:Compared with PLA,DAA has less muscle damage,more stable artificial joints and faster recovery. |
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