Objective: To retrospectively compare the mid-term effectiveness between by direct anterior approach (DAA) and by posterolateral approach in total hip arthroplasty (THA).
Methods: Between January 2009 and December 2010, 110 patients (110 hips) treated with THA and followed up more than 5 years were chosen in the study. THA was performed on 55 patients by DAA (DAA group), and on 55 patients by posterolateral approach (PL group). There was no significant difference in gender, age, body mass index, types of hip joint disease, and preoperative Harris score between 2 groups ( P>0.05). The operation time, amount of bleeding, length of hospital stay, postoperative complications, and the Harris scores were recorded and compared.
Results: There was no significant difference in operation time and length of hospital stay between 2 groups ( t=0.145， P=0.876; t=1.305, P=0.093). The amount of bleeding was significantly less in DAA group than in PL group ( t=2.314, P=0.032). All patients were followed up 5-7 years (mean, 5.97 years). Complications happened in 5 cases (9.1%) of DAA group and in 3 cases (5.5%) of PL group, and there was no significant difference in the incidence of complications between 2 groups ( χ2=0.539， P=0.463). There was significant difference in Harris scores at 6 months after operation between 2 groups ( t=2.296, P=0.014), but no significant difference was found in Harris score at 1 year and 5 years between 2 groups ( t=1.375, P=0.130; t=0.905, P=0.087). Further analysis, at 6 months after operation, the joint function score in DAA group was significantly higher than that in PL group ( t=1.087, P=0.034), while there was no significant difference in the pain score and range of motion score between 2 groups ( t=1.872, P=0.760; t=1.059, P=0.091).
Conclusion: THA by DAA has the advantages of less bleeding and faster recovery. The short-term effectiveness is superior to the THA by traditional posterolateral approach, but there is no obvious advantage in the mid-term effectiveness.
目的: 通过与传统后外侧入路比较，总结直接前方入路（direct anterior approach，DAA）人工全髋关节置换术的中期疗效。.
方法: 回顾分析 2009 年 1 月—2010 年 12 月 110 例（110 髋）行人工全髋关节置换术并随访达 5 年的患者临床资料，其中采用 DAA 手术 55 例（DAA 组），后外侧入路手术 55 例（PL 组）。两组患者性别、年龄、体质量指数、髋关节基础疾病以及术前 Harris 评分等一般资料比较，差异均无统计学意义（ P>0.05）。记录并比较两组手术时间、术中出血量和住院时间，观察并发症发生情况；采用 Harris 评分评价髋关节功能恢复情况。.
结果: DAA 组手术时间及住院时间与 PL 组比较，差异无统计学意义（ t=0.145， P=0.876； t=1.305， P=0.093）；但术中出血量较 PL 组明显减少（ t=2.314， P=0.032）。所有患者均获随访，随访时间 5～7 年，平均 5.97 年。 DAA 组 5 例（9.1%）、PL 组 3 例（5.5%）发生手术相关并发症，并发症发生率比较差异无统计学意义（ χ2=0.539， P=0.463）。术后 6 个月 DAA 组 Harris 评分显著高于 PL 组 （ t=2.296， P=0.014），1 年及 5 年两组 Harris 评分比较差异均无统计学意义（ t=1.375， P=0.130； t=0.905， P=0.087）。进一步分析术后 6 个月 DAA 组 Harris 评分中关节功能评分显著优于 PL 组（ t=1.087， P=0.034），而疼痛和活动范围评分两组比较差异无统计学意义（ t=1.872， P=0.760； t=1.059， P=0.091）。.
结论: DAA 人工全髋关节置换术具有手术出血少、术后患者康复更快的优点，其早期疗效优于传统后外侧入路手术，但中期疗效无明显优势。.
Keywords: Direct anterior approach; mid-term effectiveness; total hip arthroplsty.