Analysis Of Curative Effect Of Total Hip Replacement For Ankylosing Spondylitis With Hip Flexion Deformity Through Direct Anterior Approach And Posterolateral Approach

[Objective] To investigate the clinical effects of direct anterior approach and traditional posterolateral approach for the total hip arthroplasty in treatment of ankylosing spondylitis with hip flexion deformity.[Methods] A retrospective study was used.The clinical data of 22 AS patients(24hips)with hip flexion deformity of the first affiliated Hospital of Bengbu Medical College hospitial from June 2017 to December 2019 were taken THA.Among them,8 cases(10 hips)were treated by anterior approach,all patients were male,the age varies from 25 to 51;In the traditional posterolateral approach group,14 cases(14 hips)were posterolateral,all patients were male,the age varies from 37 to 54.Comparison of two groups perioperative parameters: operative time,bleeding volume,postoperative drainage,single hospitalization time,surgical incision length,complications.Postoperative follow-up,observation of complications,through flexion deformity degree,Harris score,VAS pain score and hip range of motion to evaluate the clinical efficacy.[Results] All the patients completed the replacement successfully,and the incision healed at I stage.The bleeding volume of anterior approach group was(113.20±13.58)m L、postoperative drainage volume was(107.50±8.36)m L、single hospitalization time were(7.40±0.97)d and incision length were(9.79±1.42)cm lower than that of posterior approach group(151.00±12.37)m L、operation Post drainage(147.00±9.96)m L、single hospitalization(10.50±1.56)d and incision length(9.79±1.42)cm,The difference was statistically significant(P <0.05),there was no significant difference in operation time and postoperative complications between the two groups(P>0.05).Patients were followed up,Time 18～36(26.19±4.69)months,A case of trochanteric fracture occurred in the posterolateral approach group,Bone healing was obtained by wire ring fixation;X-ray examination indicate there was no loosening or sinking of the prosthesis,no ectopic ossification.The degree of flexion deformity of hip joint was 13.00°±1.49° in anterior approach group better than 14.71°±1.77° in the posterolateral approach group,the hip Harris score was(91.00±1.41)points in the anterior approach group better than the posterolateral group(89.14±1.51)points,VAS score of(3.60±0.70)points in the anterior approach group was better than(4.86±0.86)points in the posterolateral group,hip range of motion was101.70°±5.14° in anterior approach group better than 95.07°±8.94° in the posterolateral approach group.There was no significant difference in total hip activity,Harris score,VAS score and hip range of motion at the last follow-up,there was no significant difference between two groups(P>0.05),There was no significant difference in excellent and good rate(P>0.05).[Conclusion] For patients with ankylosing spondylitis and hip flexion deformity Both the anterior approach and the posterolateral approach can achieve good results in total hip replacement.The former has faster recovery of joint function and shorter hospitalization time within one month of operation.