1、论著 521中国医刊 2023 年 第58卷 第5期侧卧位直接前方入路在全髋关节置换术中的应用 效果观察曹峰1，吴晓东1*，沈为苟1，杨叶2，陈阳1（1.江苏省苏州市中西医结合医院 骨伤科，江苏 苏州 215101；2.江苏省苏州市吴中人民医院 药剂科，江苏 苏州 215128）摘要：目的探讨侧卧位直接前方入路在全髋关节置换术中的应用效果。方法选取2019年1月至2022年7月在江苏省苏州市中西医结合医院实施全髋关节置换的57例患者，采用随机数字表法分为观察组（28例）和对照组（29例），观察组通过侧卧位直接前方入路行全髋关节置换，对照组通过传统后外侧入路行全髋关节置换。比较两组患者的手术时间
2、、切口长度、术中出血量、住院时间，手术前后的髋关节功能Harris评分、疼痛视觉模拟量表（visual analogue scale，VAS）评分，术后1d血清炎症因子白细胞介素-8（interleukin-8，IL-8）、肿瘤坏死因子-（tumor necrosis factor-，TNF-）、IL-6水平和外周血自然杀伤（natural killer，NK）细胞、CD3+T细胞、CD8+T细胞比例，以及两组的治疗有效率和并发症发生情况。结果两组手术时间比较差异无显著性（P0.05），观察组手术切口长度、术中出血量、住院时间明显低于对照组，差异有显著性（P0.05）。术前两组髋关节功能Har
3、ris评分及VAS评分比较差异无显著性（P0.05）；术后3d两组髋关节功能Harris评分明显高于术前，且观察组明显高于对照组，VAS评分明显低于术前，且观察组明显低于对照组，差异均有显著性（P0.05）。术后1d，观察组血清IL-8、TNF-、IL-6水平明显低于对照组，外周血NK细胞、CD3+T细胞、CD8+T细胞比例明显高于对照组，差异均有显著性（P0.05）。观察组治疗有效率（96.43%）明显高于对照组（79.31%），术后并发症发生率（3.57%）明显低于对照组（24.14%），差异均有显著性（P0.05）。结论采用侧卧位直接前方入路行全髋关节置换可有效改善髋关节功能，减轻术后炎
4、症反应，改善免疫功能，提高治疗效果。关键词：全髋关节置换；侧卧位直接前方入路；炎症反应中图分类号：R687.4文献标识码：A文章编号：1008-1070（2023）05-0521-04doi:10.3969/j.issn.1008-1070.2023.05.015Application of lateral decubitus DAA in THA and its effect on hip joint function and inflammatory responseCao Feng1,Wu Xiaodong1*,Shen Weigou1,Yang Ye2,Chen Yang1(1.Dep
5、artment of Orthopedics,Suzhou Integrated Traditional Chinese and Western Medicine Hospital,Jiangsu Suzhou 215101,China;2.Department of Pharmacy,Wuzhong Peoples Hospital,Jiangsu Suzhou 215128,China)*Corresponding author,E-mail:Abstract:Objective To investigate the application of lateral decubitus dir
6、ect anterior approach(lateral decubitus DAA)in total hip arthroplasty(THA)and its effect on hip function and inflammatory response.Method Fifty-seven patients who underwent total hip replacement from January 2019 to July 2022 at the Hospital of Integrative Medicine in Suzhou,Jiangsu Province,were se
7、lected and divided into observation group(28 patients)and control group(29 patients)using the random number table method,with the observation group undergoing total hip replacement through a direct anterior approach in the lateral recumbent position and the control group undergoing total hip replace
8、ment through a traditional postero-lateral approach.The operating time,incision length,intraoperative bleeding,hospital stay,Harris score of hip function,visual analogue scale(VAS)score of pain,serum inflammatory factor interleukin-8(IL-8)and tumor necrosis factor-(tumor necrosis),and the ratio of p
9、eripheral blood natural killer(NK)cells,CD3+T cells and CD8+T cells,as well as the treatment efficiency and complications were compared between the two groups.Result There was no significant difference in the operation time between the two groups(P0.05),and the length of surgical incision,intraopera
10、tive bleeding and hospitalization time in the observation group were significantly lower than those in the control group,with a significant difference(P0.05).There was no significant difference between the Harris score of hip function and VAS score of the two groups at 24h before surgery(P0.05);at 2
11、4h after surgery,the Harris score of hip function in both groups was significantly higher than that at 24h before surgery,and the observation group was significantly higher than the control group,and the VAS score was significantly lower than that at 24h before surgery,and the observation group was
12、significantly lower than the control group,and the difference was significant(P0.05).At 24h after surgery,the serum IL-8,TNF-and IL-6 levels in the observation group were significantly lower than those in the control group,and the proportions of peripheral blood NK cells,CD3+T cells and CD8+T cells
13、were significantly higher than those in the control group,and the differences were all significant (P0.05).The treatment efficiency of the observation group(96.43%)was significantly higher than that of the control group(79.31%),and the 24h postoperative complication rate(3.57%)was significantly lowe
14、r than that of the control group(24.14%),and all differences were significant(P0.05).Conclusion Direct anterior approach total hip arthroplasty in the lateral recumbent position can effectively improve hip function,reduce the 24-h postoperative inflammatory response,improve immune function,and enhan
15、ce the therapeutic effect.Keywords:Total hip arthroplasty;Side decubitus position with direct front approach;Inflammatory response基金项目：苏州市 2020 年度科技发展计划（SYSD2020235）*通信作者，E-mail：522 论著 中国医刊 2023 年 第58卷 第5期全髋关节置换是临床治疗股骨头坏死、髋关节强直、股骨颈骨折、髋关节肿瘤等髋关节疾病的有效方法之一1，可改善髋关节功能，保持髋关节稳定性2-3。但传统的全髋关节置换手术创伤较大，不利于患者后期恢
16、复4-5。侧卧位直接前方入路是近年来较常采用的全髋关节置换手术入路，利用自然解剖间隙到达手术部位，不损伤髋关节周围肌肉，明显降低了手术创伤，且其手术切口较小，可减少出血量，加快术后康复，减轻疼痛感，减少术后并发症的发生6-7。本研究采用侧卧位直接前方入路进行全髋关节置换手术并观察其临床效果，现报道如下。1资料与方法 1.1临床资料选取 2019 年 1 月至 2022 年 7 月在江苏省苏州市中西医结合医院实施全髋关节置换的患者 57 例，采用随机数字表法分为观察组（28 例）和对照组（29 例），观察组通过侧卧位直接前方入路行全髋关节置换，对照组通过传统后外侧入路行全髋关节置换。观察组中男 16 例，女 12 例；年龄 32 65 岁，平均（57.56.8）岁；股骨头缺血性坏死 9 例，髋关节骨关节炎 5 例，股骨颈骨折 5 例，类风湿关节炎 7 例；病程（2.50.8）年；体重指数（25.5 3.9）kg/m2。对照组中男15例，女14例；年龄3168岁，平均（58.96.4）岁；股骨头缺血性坏死 6 例，髋关节骨关节炎 7 例，股骨颈骨折 5 例，类风湿关节炎 7 例；病程（2.