Objective: To compare the short-term effectiveness of staged bilateral total hip arthroplasty via different approaches.
Methods: Thirty-two patients (64 hips) with bilateral hip disease were treated with total hip arthroplasty between January 2012 and December 2014. There were 20 males and 12 females with the mean age of 45.3 years (range, 30-67 years). There were avascular necrosis of femoral head in 14 cases, developmental dislocation of the hip in 12 cases, ankylosing spondylitis in 4 cases, osteoarthritis in 2 cases. All patients were treated with total hip arthroplasty; and the direct anterior approach (DAA) or direct lateral approach (DLA) was chosen for the unilateral hip randomly. The length of incision, operation time, total blood loss volume, the time of first postoperative activity, and the acetabular anteversion angle were compared. The Harris score, visual analogue scale (VAS) score, and incidence of complication were compared between 2 groups.
Results: All incisions healed at stage Ⅰ. All patients were followed up 20-53 months (mean, 39.6 months). The length of incision, total blood loss volume, the time of first postoperative activity were significantly shorter in DAA group than in DLA group ( P<0.05). The operation time was significantly longer in DAA group than in DLA group ( P<0.05). There was no significant difference in acetabular anteversion angle between 2 groups ( t=1.122, P=0.266). The incidence of complication were 25.00% and 15.63% in DAA group and DLA group, respectively, showing no significant difference ( χ2=0.869, P=0.536). The Harris score in DAA group significantly increased at 3 and 9 months after operation than in DLA group ( P<0.05); there was no significant difference at 18 months after operation between 2 groups ( P>0.05). The VAS score was significantly lower in DAA group than in DLA group at 1 day, 3 days, and 1 week after operation ( P<0.05); there was no significant difference at 4 and 8 weeks between 2 groups ( P>0.05). The prosthesis did not loosen and sink during the follow-up.
Conclusion: Total hip arthroplasty via DAA can reduce operation related complication and speed up the recovery of hip function at the early stage after operation. However, the lateral cutaneous nerve injury is the most common complication.
目的: 对分期行双侧人工全髋关节置换术患者分别采用髋关节直接前方入路（direct anterior approach，DAA）以及直接外侧入路（direct lateral approach，DLA），比较两种手术入路置换术后早期临床疗效。.
方法: 2012 年 1 月—2014 年 12 月，收治 32 例双侧髋关节疾病患者。男 20 例，女 12 例；年龄 30～67 岁，平均 45.3 岁。股骨头缺血性坏死 14 例，髋关节发育不良 12 例，强制性脊柱炎累及双侧髋关节 4 例，骨关节炎 2 例。分期行人工全髋关节置换术，随机选取一侧采用 DAA，另一侧采用 DLA。比较两侧切口长度、手术时间、总失血量、术后下床活动时间及术后髋臼假体前倾角；比较两组术后髋关节 Harris 评分、疼痛视觉模拟评分（VAS）以及并发症发生率等。.
结果: 术后患者切口均 Ⅰ 期愈合。患者均获随访，随访时间 20～53 个月，平均 39.6 个月。DAA 组切口长度、总失血量、术后下床活动时间均低于 DLA 组，但手术时间较 DLA 组明显延长，差异有统计学意义（ P<0.05）。两组髋臼假体前倾角比较，差异无统计学意义（ t=1.122， P=0.266）。DAA 组及 DLA 组并发症发生率分别为 25.00% 与 15.63%，差异无统计学意义（ χ2=0.869， P=0.536）。术后各时间点两组 Harris 评分均较术前显著提高，差异有统计学意义（ P<0.05）；DAA 组术后 3、9 个月时 Harris 评分较 DLA 组显著升高（ P<0.05），但术后 18 个月两组间比较差异无统计学意义（ P>0.05）。术后 1、3 d 及 1 周，DAA 组 VAS 评分显著低于 DLA 组（ P<0.05）；术后 4、8 周两组间比较差异无统计学意义（ P>0.05）。术后 X 线片复查，随访期间假体均无松动、下沉等。.
结论: 相对于 DLA，采用 DAA 行人工全髋关节置换术具有创伤小、加快术后髋关节功能恢复等优势，早期疗效较好，但易并发股外侧皮神经损伤。.
Keywords: Total hip arthroplasty; direct anterior approach; direct lateral approach; short-term effectiveness.