| BackgroundTotal hip arthroplasty（THA）is an important method for the treatment of end-stage hip joint disease.There are various surgical methods for THA,and which approach can obtain a more ideal clinical effect has always been a hot topic of debate.Posterior approach（PA）requires severing the external rotator muscle group,resulting in reduced joint stability and easy posterior dislocation,which affects the postoperative rehabilitation of patients.In recent years,with the rapid development of minimally invasive surgical techniques,the direct anterior approach（DAA）has the advantages of less trauma and faster postoperative functional recovery,and is gradually favored by more clinicians.Therefore,the DAA approach is comprehensively evaluated.Its efficacy and safety are of great significance for its clinical application and promotion.ObjectiveA retrospective analysis and comparison of the clinical data of patients using the PA and DAA approaches in the staged double hip replacement,the advantages and disadvantages of the two approaches were compared,and the complications and safety of the DAA approach were observed and analyzed,and to explore the clinical application value of DAA approach.MethodsThe clinical data of patients who underwent THA with DAA or PA in the First Affiliated Hospital of Xinxiang Medical College from September 2019 to June 2021 were collected,a total of 64 cases（128 hips）met the selection criteria and were included in the study,They were grouped according to different surgical methods.In the DAA group,32cases（64 hips）underwent staged double hip replacement with DAA,and in the PA group,32 cases（64 hips）underwent staged double hip replacement with PA.32 cases in the DAA group（22 males and 10 females）,aged 45-75 years,mean（65.5±8.7）years old,body mass index（23.9±4.5）kg/m~2.21 cases of avascular necrosis of the femoral head（9 cases of Ficat stage III,12 cases of Ficat stage IV）,1 case of hip dysplasia（Crowe type 2）,and 10cases of end-stage hip osteoarthritis;32 cases in the DAA group（22 males and 10 females）,aged 46 to 82 years,mean（67.5±8.2）years old,body mass index（25.2±4.7）kg/m~2.16cases of avascular necrosis of the femoral head（6 cases of Ficat stage III,10 cases of Ficat stage IV）,3 cases of hip dysplasia（1 case of Crowe type 1,2 cases of Crowe type 2）,13cases of end-stage hip osteoarthritis.By reviewing clinical and anesthesia system data,follow-up through outpatient and other methods,recording and evaluating preoperative and postoperative data,including operation time,intraoperative blood loss,incision length,acetabular prosthesis anteversion angle and abduction angle,hospitalization time,intraoperative and postoperative complications and leg-length discrepancy;Postoperative follow-up used the psychological component summary MCS and body composition summary PCS in the SF-36（short-form 36 item health survey questionnaire）to evaluate the quality of life;Harris score and pain visual analogue scale（VAS）were used to evaluate the clinical efficacy;the concentrations of creatine kinase（CK）and C-reactive protein（CRP）were recorded before surgery,1d and 4d after surgery Changes assess the extent of hip muscle damage.Results（1）Compared with the PA group,the DAA group had shorter incision length,fewer postoperative hospitalization days,and less intraoperative blood loss,but the operation time was prolonged,and the differences were statistically significant（P<0.05）;（2）There was no significant difference in the anteversion angle,abduction angle and postoperative LLD of the acetabular prosthesis between the two groups.（P>0.05）;（3）The CK and CRP of the DAA group at 1 and 4 days after operation were significantly lower than those in the PA group,and the difference was statistically significant（P<0.05）;（4）In the DAA group,there were 2 cases（3.1%）of lateral femoral cutaneous nerve injury,2 cases（3.1%）of intraoperative greater trochanter fracture,and 1 cases（1.6%）of tensor fascia lata injury,with a total complication rate of 7.8%（5/64%）;in the PA group,1cases（1.6%）had posterior dislocation of the hip joint,1 case（1.6%）had superficial soft tissue infection,and 2 cases（3.1%）had postoperative intermuscular venous thrombosis in the affected limb,with a total complication rate of 6.3%（4/64）.there was no significant difference in the total incidence of complications between the two groups（χ~2=0.119,P=0.731）;（5）The VAS and Harris scores at each time point after operation in the two groups were significantly improved compared with those before operation（P<0.05）.The VAS scores of the DAA group at 1 and 3 days after operation were significantly better than those of the PA group（P<0.05）.The DAA group at 5 days and 1 month after operation Harris hip function score was significantly better than PA group（P<0.05）,but there was no significant difference in VAS score at 2 weeks after operation and Harris hip function score at 6 months after operation（P>0.05）.The psychological composition summary（MCS）and body composition summary（PCS）of the DAA group were significantly better than those of the PA group at 6 months postoperatively（P<0.05）.Conclusion1.Both approaches can effectively improve hip function and improve the quality of life of patients with THA,and the complication rates are similar.2.DAA has obvious advantages in the early postoperative period,less trauma,shorter hospital stay,accelerated hip function recovery,higher quality of life,especially in terms of psychological component summary（MCS）. |
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