發(fā)布時(shí)間：2018-05-02 20:49

  本文選題：直接 + 前路　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:全髖關(guān)節(jié)置換術(shù)是目前股骨頭壞死的主要治療手段。就外科手術(shù)技術(shù)及內(nèi)植物材料而言,全髖關(guān)節(jié)置換術(shù)經(jīng)歷了許多階段。隨著時(shí)間的推移,手術(shù)的各個(gè)方面均得到了改進(jìn),使病人和醫(yī)生更加受益。目前全髖關(guān)節(jié)置換有多種手術(shù)方法,這些方法都有各自的優(yōu)點(diǎn)和缺點(diǎn)。目前最常用的兩種方法是直接前路或后路手術(shù)。為了找到最佳的手術(shù)方法,雖然有學(xué)者已經(jīng)進(jìn)行了許多研究,但目前學(xué)術(shù)界尚未達(dá)成共識(shí)。在本研究中,作者試圖通過(guò)回顧本科室的相關(guān)手術(shù)資料對(duì)比研究直接前方入路和后外側(cè)入路,尋找股骨頭壞死全髖關(guān)節(jié)置換術(shù)的最佳手術(shù)入路。為了達(dá)到這個(gè)目的,作者對(duì)術(shù)前、術(shù)中及術(shù)后的指標(biāo)進(jìn)行測(cè)量、統(tǒng)計(jì)分析,并結(jié)合了術(shù)后并發(fā)癥的研究。病人資料與研究方法:本研究在大連醫(yī)科大學(xué)醫(yī)院關(guān)節(jié)外科進(jìn)行,針對(duì)的是2014年9月至2016年12月收治的,接受全髖關(guān)節(jié)置換術(shù)的股骨頭壞死病人。我們共選取了78位患者,年齡范圍在39歲到89歲之間。根據(jù)手術(shù)入路的不同,將78位患者分為兩組:直接前入路組(DAA)和后外側(cè)入路組(PA)。DAA組中包括35例患者,其中20名女性,15名男性,年齡范圍在44歲至89歲之間。PA組包括43例患者,其中20名女性23名男性,年齡范圍在39歲至81歲之間。比較和回顧研究主要基于以下參數(shù):(1)一般資料:(a)年齡,(b)性別(c)體重指數(shù)(BMI);(2)術(shù)前參數(shù):(a)Harris髖關(guān)節(jié)評(píng)分,HHS(術(shù)前)(b)血紅蛋白指標(biāo)(術(shù)前);(3)術(shù)中參數(shù):(a)手術(shù)時(shí)長(zhǎng);(b)術(shù)中失血量;(4)術(shù)后參數(shù)(a)術(shù)后出血量(引流袋中的血量),(b)血紅蛋白值的差異(術(shù)前和術(shù)后比較),(c)術(shù)后住院天數(shù),(d)術(shù)后不同時(shí)間段的Harris髖關(guān)節(jié)評(píng)分(分別為2周,4周,6周,12周,6個(gè)月,1年),(e)術(shù)后的影像學(xué)并發(fā)癥(移位和骨折)。數(shù)據(jù)采用SSPS軟件22.0分析,進(jìn)行描述性統(tǒng)計(jì),應(yīng)用t檢驗(yàn),皮爾森相關(guān)和重復(fù)測(cè)量方法。結(jié)果:直接前入路組(DAA)的平均年齡是59.83±9.473歲,后外側(cè)入路組(PA)的平均年齡是55.74±9.781歲。年齡的差異(t=1.860,P=0.067)和性別差異(x2=0.873,P=0.350)無(wú)統(tǒng)計(jì)學(xué)意義。DAA組患者的平均體重指數(shù)(BMI)為24.978±3.002kg/m2(范圍:19.03-30.86 kg/m2)。PA組患者的平均體重指數(shù)(BMI)為25.189±3.009 kg/m2(范圍:18.67-31.25 kg/m2)。平均體重指數(shù)(BMI)的差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-0.309,p=0.758).術(shù)前參數(shù):術(shù)前DAA組Harris髖關(guān)節(jié)評(píng)分(HHS)是44.00±7.046,PA組的是44.70±10.232.該項(xiàng)結(jié)果無(wú)統(tǒng)計(jì)學(xué)意義上的差異(t=-0.342 p=0.733)。術(shù)前DAA組血紅蛋白的平均值為13.157±1.398 g/d L,PA組的是13.714±1.509 g/d L.該項(xiàng)結(jié)果差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-1.675,p=0.098).術(shù)中參數(shù):DAA組手術(shù)平均耗時(shí)(81.86±13.778分鐘)長(zhǎng)于PA組(77.79±13.597分鐘)。該項(xiàng)結(jié)果差異無(wú)統(tǒng)計(jì)學(xué)意義(t=1.306,p=0.196).DAA組術(shù)中平均失血量(275.71±129.689 m L)少于PA組(324.42±153.674 m L)。該項(xiàng)結(jié)果差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-1.491,p=0.140).術(shù)后參數(shù):DAA組術(shù)后住院時(shí)間(14.31±5.90天)短于PA組(15.12±7.13天)。該項(xiàng)結(jié)果差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-0.533,p=0.595)。DAA組術(shù)前和術(shù)后的血紅蛋白值差異(2.074±1.283 g/d L)低于PA組(2.595±1.310 g/d L)。該項(xiàng)結(jié)果差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-1.764,p=0.082)。DAA組術(shù)后傷口平均失血量(223.57±118.195 m L)少于PA組(254.42±114.024 m L)。該項(xiàng)結(jié)果差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-1.169,p=0.246)。DAA組和PA組在術(shù)后兩周、四周及六周的Harris髖關(guān)節(jié)評(píng)分(HHS)差異具有顯著的統(tǒng)計(jì)學(xué)意義。術(shù)后兩周,DAA組HHS的平均值(53.60±4.888)高于PA組(47.00±6.381);t=7.627,p=0.000。術(shù)后四周,DAA組HHS的平均值(66.74±2.683)高于PA組(62.84±1.825);t=7.627,p=0.000。術(shù)后六周,DAA組HHS的平均值(78.17±4.253)高于PA組(72.51±1.932);t=7.802,p=0.000。當(dāng)術(shù)后十二周,六個(gè)月,一年后再次測(cè)評(píng)HHS,DAA組和PA組無(wú)顯著差異。PA組的BMI與HHS在術(shù)后兩周呈負(fù)相關(guān),此結(jié)果具有統(tǒng)計(jì)學(xué)意義(r=-0.331,p=0.030).在本研究中,兩組病例均無(wú)術(shù)后并發(fā)癥(移位、骨折等情況)出現(xiàn),所以無(wú)法在本研究中進(jìn)行比較并發(fā)癥的發(fā)生率。結(jié)論:本研究表明,采用Harris髖關(guān)節(jié)評(píng)分法(HHS)評(píng)估的早期功能比較結(jié)果的差異,是DAA組和PA組兩組間的主要差異,而其他數(shù)據(jù)無(wú)顯著統(tǒng)計(jì)學(xué)差異,即使是有差異的早期功能評(píng)分,在術(shù)后12周,6個(gè)月,1年后再次測(cè)評(píng),兩組無(wú)顯著差異。那么,只基于單一因素?zé)o法判定DAA入路是否優(yōu)于PA入路,目前的實(shí)際臨床工作中,兩種手術(shù)入路具有各自的特點(diǎn),臨床醫(yī)生針對(duì)大部分病人,選用合適的入路,都能很好地實(shí)施全髖關(guān)節(jié)置換術(shù),獲得滿意的功能重建。最佳的手術(shù)入路取決于患者的自身狀況及術(shù)者經(jīng)驗(yàn)。在選擇股骨頭壞死手術(shù)入路之前需要結(jié)合幾個(gè)因素來(lái)考慮。通過(guò)本研究,進(jìn)一步為臨床工作提供了參考數(shù)據(jù)
[Abstract]:Background: total hip arthroplasty is the main treatment for osteonecrosis of the femoral head. Total hip arthroplasty has undergone many stages in terms of surgical techniques and internal plant materials. With time, all aspects of the operation have been improved to make patients and doctors benefit more. There are many kinds of surgical methods for total hip replacement. These methods have their own advantages and disadvantages. The two most commonly used methods are direct anterior or posterior operation. In order to find the best method of operation, many scholars have done a lot of research, but there is no consensus in the academic circle. In this study, the author tries to look back on the related surgical data of the undergraduate room. In order to achieve this goal, the authors measured the preoperative, intraoperative and postoperative indexes, statistical analysis, and combined with the study of postoperative complications. Patients' materials and research methods: This study was at the Dalian Medical University hospital. Joint surgery was performed on the patients with femoral head necrosis who received total hip replacement from September 2014 to December 2016. We selected 78 patients aged from 39 to 89 years old. According to the different surgical approaches, 78 patients were divided into two groups: the direct anterior approach group (DAA) and the posterolateral approach group (PA) group.DAA Including 35 patients, of which 20 women and 15 men, age range from 44 to 89 years old, including 43 patients, 20 women and 23 men, age range from 39 to 81 years old. The comparison and retrospective study is based on the following parameters: (a) age, (b) sex (c) body mass index (BMI); (2) preoperative parameters: (a) Harris Hip score, HHS (preoperative) (preoperative) (b) hemoglobin index (preoperative); (3) intraoperative parameters: (a) long operation time; (b) blood loss during operation; (4) postoperative parameters (a) bleeding volume (blood volume in drainage bag), (b) difference in hemoglobin value (preoperative and postoperative comparison), (c) postoperative hospital days, and (d) the Harris hip joint score at different time after operation (2) (2) Weeks, 4 weeks, 6 weeks, 12 weeks, 6 months, 1 years, and (E) postoperative imaging complications (displacement and fracture). Data were analyzed with SSPS software 22, descriptive statistics, t test, Pearson correlation and repeated measurements. Results: the average age of the direct anterior approach group (DAA) was 59.83 + 9.473 years, and the average age of the posterolateral approach group (PA) was 55.74 +. 9.781 years of age. Age differences (t=1.860, P=0.067) and gender differences (x2=0.873, P=0.350), the average body mass index (BMI) of the.DAA group was 24.978 + 3.002kg/m2 (range: 19.03-30.86 kg/m2).PA group, the average body mass index (BMI) was 25.189 + 3.009 kg/m2 (range: average body mass index). No statistical significance (t=-0.309, p=0.758). Preoperative parameters: preoperative DAA group Harris hip joint score (HHS) was 44 + 7.046, PA group was 44.70 + 10.232. and there was no statistical difference (t=-0.342 p=0.733). The mean value of hemoglobin in the DAA group before operation was 13.157 + 1.398 g/d L, and 13.714 + 1.509 No statistical significance (t=-1.675, p=0.098). Intraoperative parameters: the average time of operation in group DAA (81.86 + 13.778 minutes) was longer than that of group PA (77.79 + 13.597 minutes). There was no statistically significant difference (275.71 + 129.689 m L) in group.DAA (275.71 + 129.689 m L) in group.DAA (324.42 + 153.674 m L). There was no significant difference between the results of the results of the group (324.42 + 153.674 m L). (t=-1.491, p=0.140) after operation: the time of postoperative hospitalization in group DAA (14.31 + 5.90 days) was shorter than group PA (15.12 + 7.13 days). There was no statistically significant difference (t=-0.533, p=0.595) in group.DAA (2.074 + 1.283 g/d L) before and after operation (2.595 + 1.310 g/d L). =0.082) the average blood loss in group.DAA after operation (223.57 + 118.195 m L) was less than that in group PA (254.42 + 114.024 m L). There was no statistical significance (t=-1.169, p=0.246) in.DAA group and PA group at two weeks after operation, and the difference between the four weeks and six weeks was statistically significant. Two weeks after the operation, the average value (53.) 60 + 4.888) was higher than that of group PA (47 + 6.381); t=7.627, after p=0.000., the mean value of HHS in group DAA was higher than that in group PA (62.84 + 1.825); t=7.627, 6 weeks after p=0.000., and the average value of HHS in group DAA (78.17 + 4.253) higher than that in PA group (72.51 + 1.932). There was no significant difference in group.PA between BMI and HHS at two weeks postoperatively. The results were statistically significant (r=-0.331, p=0.030). In this study, there were no postoperative complications (displacement, fracture, etc.) in the two groups, so there was no comparison and incidence of complications in this study. Conclusion: this study showed that Harris hip joint was used in this study. The difference between the results of the early functional comparison of the score method (HHS) was the main difference between the two groups in group DAA and group PA, but there was no significant difference in other data. Even if there was a different early functional score, there was no significant difference between the two groups at 12 weeks, 6 months, and 1 years after the operation. Then, only a single factor could not determine whether the DAA approach was in the way. In the actual clinical work, two kinds of surgical approaches have their own characteristics in the actual clinical work. The clinicians can perform the total hip replacement and obtain satisfactory functional reconstruction. The best approach depends on the patient's own condition and the experience of the surgeon. There are several factors to consider before the operation of necrotizing. This study provides reference data for clinical work.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 Keith P Connolly;Atul F Kamath;;Direct anterior total hip arthroplasty: Literature review of variations in surgical technique[J];World Journal of Orthopedics;2016年01期

2 Joseph T Moskal;Susan G Capps;John A Scanelli;;Anterior muscle sparing approach for total hip arthroplasty[J];World Journal of Orthopedics;2013年01期

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本文編號(hào)：1835454