本文選題：關節(jié)成形術 + 置換��； 參考：《北京大學學報(醫(yī)學版)》2017年02期

【摘要】：目的:探討直接前入路(direct anterior approach,DAA)行人工全髖關節(jié)置換術后早期效果及患者手術前后的步態(tài)變化。方法:20例因股骨頭壞死或髖關節(jié)發(fā)育不良繼發(fā)骨關節(jié)炎的患者于直接前入路下行單側初次人工關節(jié)置換,采集患者一般資料并記錄患者術前、術后視覺模擬評分(visual analogue scale,VAS)、Harris評分等,分別于手術前及手術后6周、12周行步態(tài)分析,記錄并分析患者手術前后步態(tài)變化并與正常成人對比。結果:患者術后平均住院時間3.3 d,術后3 d內(nèi)VAS評分均低于4分,患者假體安放位置滿意,至術后12周隨訪無脫位。步態(tài)分析結果中,步速患者組為術前0.64 m/s、術后6周0.77 m/s、術后12周1.07 m/s,正常對照組為1.19 m/s;步頻患者組為術前43.15步/min、術后6周51.42步/min、術后12周55.52步/min,正常對照組為57.15步/min;行走時髖關節(jié)活動度患者組為術前31.00°、術后6周39.62°、術后12周40.40°,正常對照組為45.67°;行走時膝關節(jié)活動度患者組為術前50.52°、術后6周59.28°、術后12周67.29°,正常對照組為70.42°�；颊呓M內(nèi)比較,除術后6周的步速和行走時膝關節(jié)活動度外其他數(shù)據(jù)差異均有統(tǒng)計學意義;與正常對照組相比,入組患者的步態(tài)分析數(shù)據(jù)仍不及正常對照,術后12周時患者步態(tài)數(shù)據(jù)已接近正常對照組,步速、步頻、行走時膝關節(jié)活動度結果組間差異無統(tǒng)計學意義。結論:DAA作為全髖關節(jié)置換的可選手術入路,患者術后12周步態(tài)已接近正常人群,但尚需進一步的更大樣本量的研究。
[Abstract]:Objective: to investigate the early effect of direct anterior approach to total hip arthroplasty (THR) and the gait changes of the patients before and after operation. Methods Twenty patients with osteoarthritis secondary to osteonecrosis of femoral head or dysplasia of hip joint underwent unilateral primary arthroplasty via direct anterior approach. The general data of the patients were collected and the visual analogue scores before and after operation were recorded. Gait analysis was performed before operation and 6 weeks and 12 weeks after operation. Gait changes before and after operation were recorded and analyzed and compared with normal adults. Results: the average hospitalization time was 3.3 days, and the VAS score was lower than 4 points within 3 days after operation. The prosthesis placement was satisfactory, and no dislocation was found at 12 weeks after operation. Gait analysis results, The walking rate group was 0.64 m / s before operation, 0.77 m / s at 6 weeks postoperatively, 1.07 m / s at 12 weeks after operation, and 1.19 m / s in normal control group, 43.15 steps per minute before operation, 51.42 steps / min at 6 weeks after operation, 55.52 steps / min at 12 weeks after operation and 57.15 steps / min in normal control group respectively. The range of motion was 31.00 擄before operation, 39.62 擄at 6 weeks after operation, 40.40 擄at 12 weeks after operation, 45.67 擄in normal control group, 50.52 擄before operation, 59.28 擄at 6 weeks after operation, 67.29 擄at 12 weeks after operation and 70.42 擄in normal control group. Compared with the control group, the gait analysis data of the patients were not as good as those of the normal control group, except the walking speed at 6 weeks after operation and the knee joint motion at the time of walking, and the gait analysis data of the patients in the group were not as good as those in the normal control group. At 12 weeks after operation, the gait data of the patients were close to that of the normal control group, and there was no significant difference between the two groups in the results of step speed, gait frequency and knee joint motion during walking. Conclusion as an alternative approach to total hip replacement, the gait of the patients at 12 weeks after operation is close to the normal population, but further research is needed.
【作者單位】： 四川大學華西醫(yī)院骨科;
【基金】：衛(wèi)生部衛(wèi)生公益性行業(yè)科研專項(201302007)資助~~
【分類號】：R687.4

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