[1]陈彭雷,阮鹏飞,吴聪,等.不同入路全髋关节置换术后患者早期骨密度与步态差异及两者关系分析[J].中国中医骨伤科杂志,2023,31(12):28-33.[doi:10.20085/j.cnki.issn1005-0205.231206]
　CHEN Penglei,RUAN Pengfei,WU Cong,et al.Analysis of the Early Differences of Bone Mineral Density and Gait in Patients after Total Hip Arthroplasty via Different Approaches and Their Relationship[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2023,31(12):28-33.[doi:10.20085/j.cnki.issn1005-0205.231206]
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不同入路全髋关节置换术后患者早期骨密度与步态差异及两者关系分析()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第31卷
期数:
2023年12期
页码:
28-33
栏目:
临床研究
出版日期:
2023-12-15

文章信息/Info

Title:
Analysis of the Early Differences of Bone Mineral Density and Gait in Patients after Total Hip Arthroplasty via Different Approaches and Their Relationship
文章编号:
1005-0205(2023)12-0028-06
作者:
陈彭雷1; 阮鹏飞1; 吴聪1; 曾纪诚1; 沈景2; 季卫锋2△
1浙江中医药大学第一临床医学院(杭州, 310006); 2浙江省中医院
Author(s):
CHEN Penglei1; RUAN Pengfei1; WU Cong1; ZENG Jicheng1; SHEN Jing2; JI Weifeng2△
1The First Clinical Medical College,Zhejiang Chinese Medical University,Hangzhou 310006,China; 2Zhejiang Provincial Hospital of Chinese Medicine,Hangzhou 310020,China.
关键词:
全髋关节置换;  骨密度;  步态;  直接前方入路;  后侧入路
Keywords:
total hip arthroplasty;  bone mineral density;  gait;  direct anterior approach;  posterior approach
分类号:
R687.4
DOI:
10.20085/j.cnki.issn1005-0205.231206
文献标志码:
A
摘要:
目的:比较分析直接前入路和后侧入路全髋关节置换术后早期患者骨密度与步态差异,并观察骨密度与步态是否存在相关性。方法:纳入自2021年10月至2022年3月诊断为股骨头坏死,并完成初次单侧全髋关节置换术的76例患者为研究对象,根据手术方式不同分为两组,40例采用直接前入路(直接前入路组),36例采用后侧入路(后侧入路组)。回顾分析两组手术前后步长、步幅、步速、患肢单支撑相占步态周期百分比及骨密度值。结果:76例患者均配合完成至少3个月随访。直接前入路组和后侧入路组术后1周、1个月及3个月的步态指标较术前明显改善,术后1个月及3个月的骨密度值较术后1周明显改善,且直接前入路组术后 1周、1个月和3个月步长、步频、患肢单支撑相占步态周期百分比及术后1个月和3个月骨密度值均优于后侧入路组,差异均有统计学意义(P<0.05); 直接前入路组与后侧入路组术后1个月及3个月步态指标与骨密度值均呈正相关性(r>0,P<0.05)。结论:直接前入路全髋关节置换术后早期患者步态恢复与骨密度改善程度均优于后侧入路全髋关节置换术患者,且步态与骨密度正相关。
Abstract:
Objective:To compare and analyze the differences of bone mineral density(BMD)and gait in patients with total hip arthroplasty(THA)by direct anterior approach and posterior approach at the early stage after operation,and to observe the correlation between BMD and gait.Methods:A total of 76 patients who were diagnosed with osteonecrosis of the femoral head and underwent primary unilateral total hip arthroplasty in hospital from October 2021 to March 2022 were included in the study.According to the different surgical methods,they were divided into two groups:40 cases were treated with direct anterior approach(direct anterior approach group)and 36 cases with posterior approach(posterior approach group).The step length,stride length,gait speed,percentage of single support phase in gait cycle,and BMD of the affected limb before and after operation were retrospectively analyzed.Results:All patients completed at least 3 months of follow-up.The gait indexes of the direct anterior approach group and the posterior approach group were significantly improved at 1 week,1 month and 3 months after operation,and the BMD at 1 month and 3 months after operation was significantly improved compared with that at 1 week after operation.The step length,step frequency,percentage of single support phase in gait cycle of the affected limb at 1 week,1 month,and 3 months after operation,and BMD at 1 month and 3 months after operation in the direct anterior approach group were significantly better than those in the posterior approach group(P<0.05).There was a positive correlation between gait index and BMD at 1 month and 3 months after operation in both groups(r>0,P<0.05).Conclusion:The gait recovery and BMD improvement in the early stage after total hip arthroplasty by direct anterior approach are better than those by posterior approach,and there is a certain positive correlation between gait and BMD.

参考文献/References:

[1] KAYANI B,KONAN S,CHANDRAMOHAN R,et al.The direct superior approach in total hip arthroplasty[J].British Journal of Hospital Medicine,2019,80(6):320-324.
[2] SEAH S,QUINN M,TIROSH O,et al.Postoperative opioid consumption after total hip arthroplasty:acomparison of three surgical approaches[J].The Journal of Arthroplasty,2019,34(11):2676-2680.
[3] PEETERS C M M,VISSER E,VAN DE REE C L P,et al.Quality of life after hip fracture in the elderly:a systematic literature review[J].Injury,2016,47(7):1369-1382.
[4] POST Z D,OROZCO F,DIAZ-LEDEZMA C,et al.Direct anterior approach for total hip arthroplasty:indications,technique,and results[J].The Journal of the American Academy of Orthopaedic Surgeons,2014,22(9):595-603.
[5] AIT MOKHTAR M.Postero-posterolateral approach in total hip arthroplasty[J].International Orthopaedics,2020,44(12):2577-2585.
[6] CHENG T E,WALLIS J A,TAYLOR N F,et al.A prospective randomized clinical trial in total hip arthroplasty-comparing early results between the direct anterior approach and the posterior approach[J].The Journal of Arthroplasty,2017,32(3):883-890.
[7] 王元,李勤,崔尼尼,等.直接前入路与外侧入路全髋关节置换术后早期患者步态分析[J].中国骨与关节损伤杂志,2022,37(6):566-570.
[8] MENEGHINI R M,PAGNANO M W,TROUSDALE R T,et al.Muscle damage during MIS total hip arthroplasty:Smith-Petersen versus posterior approach MIS[J].Clinical Orthopaedics and Related Research,2006,453:293-298.
[9] BREMER A K,KALBERER F,PFIRRMANN C W A,et al.Soft-tissue changes in hip abductor muscles and tendons after total hip replacement:comparison between the direct anterior and the transgluteal approaches[J].The Journal of Bone and Joint Surgery:British Volume,2011,93(7):886-889.
[10] CHEN W,SUN J N,ZHANG Y,et al.Direct anterior versus posterolateral approaches for clinical outcomes after total hip arthroplasty:a systematic review and meta-analysis[J].Journal of Orthopaedic Surgery and Research,2020,15(1):231.
[11] 中国医师协会骨科医师分会骨循环与骨坏死专业委员会,中华医学会骨科分会骨显微修复学组,国际骨循环学会中国区.中国成人股骨头坏死临床诊疗指南(2020)[J].中华骨科杂志,2020,40(20):1365-1376.
[12] CHECHIK O,KHASHAN M,LADOR R,et al.Surgical approach and prosthesis fixation in hip arthroplasty world wide[J].Archives of Orthopaedic and Trauma Surgery,2013,133(11):1595-1600.
[13] JI W,STEWART N.Fluoroscopy assessment during anterior minimally invasive hip replacement is more accurate than with the posterior approach[J].International Orthopaedics,2016,40(1):21-27.
[14] MCGOLDRICK N P,ANTONIADES S,EL MENIAWY S,et al.Supine versus lateral position for total hip replacement:accuracy of biomechanical reconstruction[J].Archives of Orthopaedic and Trauma Surgery,2022,142(10):2945-2955.
[15] WU H,CHENG W D,JING J.Total hip arthroplasty by direct anterior approach in the lateral position for the treatment of ankylosed hips[J].European Journal of Orthopaedic Surgery & Traumatology:Orthopedie Traumatologie,2020,30(6):993-1001.
[16] QUEEN R M,BUTLER R J,WATTERS T S,et al.The effect of total hip arthroplasty surgical approach on postoperative gait mechanics[J].The Journal of Arthroplasty,2011,26(6 Suppl):66-71.
[17] FOUCHER K C,FREELS S.Preoperative factors associated with postoperative gait kinematics and kinetics after total hip arthroplasty[J].Osteoarthritis and Cartilage,2015,23(10):1685-1694.
[18] ZOMAR B O,BRYANT D,HUNTER S,et al.A randomised trial comparing spatio-temporal gait parameters after total hip arthroplasty between the direct anterior and direct lateral surgical approaches[J].Hip International:The Journal of Clinical and Experimental Research on Hip Pathology and Therapy,2018,28(5):478-484.
[19] VARIN D,LAMONTAGNE M,BEAUL P E.Does the anterior approach for THA provide closer-to-normal lower-limb motion?[J].The Journal of Arthroplasty,2013,28(8):1401-1407.
[20] YOO J I,CHA Y H,KIM K J,et al.Gait analysis after total hip arthroplasty using direct anterior approach versus anterolateral approach:a systematic review and meta-analysis[J].BMC Musculoskeletal Disorders,2019,20(1):63.
[21] WINTHER S B,HUSBY V S,FOSS O A,et al.Muscular strength after total hip arthroplasty:a prospective comparison of 3 surgical approaches[J].Acta Orthopaedica,2016,87(1):22-28.
[22] BAKER A S,BITOUNIS V C.Abductor function after total hip replacement:an electromyographic and clinical review[J].The Journal of Bone and Joint Surgery:British Volume,1989,71(1):47-50.
[23] KLAUSMEIER V,LUGADE V,JEWETT B A,et al.Is there faster recovery with an anterior or anterolateral THA? A pilot study[J].Clinical Orthopaedics and Related Research,2010,468(2):533-541.
[24] RYKOV K,MEYS T W G M,KNOBBEN B A S,et al.MRI assessment of muscle damage after the posterolateral versus direct anterior approach for THA(Polada Trial):a randomized controlled trial[J].The Journal of Arthroplasty,2021,36(9):3248-3258.
[25] AGTEN C A,SUTTER R,DORA C,et al.MR imaging of soft tissue alterations after total hip arthroplasty:comparison of classic surgical approaches[J].European Radiology,2017,27(3):1312-1321.
[26] TARANTINO U,BALDI J,SCIMECA M,et al.The role of sarcopenia with and without fracture[J].Injury,2016,47(Suppl 4):S3-S10.
[27] BETTIS T,KIM B J,HAMRICK M W.Impact of muscle atrophy on bone metabolism and bone strength:implications for muscle-bone crosstalk with aging and disuse[J].Osteoporosis International,2018,29(8):1713-1720.
[28] PEARCE A N,STAMBOUGH J B,MEARS S C,et al.Diagnosis and treatment options of abductor insufficiency after total hip replacement[J].The Orthopedic Clinics of North America,2022,53(3):255-265.
[29] HALVARSSON A,FRANZ N E,STHLE A.Balance training with multi-task exercises improves fall-related self-efficacy,gait,balance performance and physical function in older adults with osteoporosis:a randomized controlled trial[J].Clinical Rehabilitation,2015,29(4):365-375.
[30] SU R,FENG W,LIU X,et al.Early rehabilitation and periprosthetic bone environment after primary total hip arthroplasty:a randomized controlled trial[J].Orthopaedic Surgery,2021,13(5):1521-1531.

备注/Memo

备注/Memo:
△通信作者 E-mail:jiweifeng1230@163.com
更新日期/Last Update: 2023-12-10