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Abstract：
OBJECTIVE: Compared to the posterior approach (PA), the direct anterior approach (DAA) can achieve better clinical outcomes for total hip arthroplasty (THA). The purpose of this study was to investigate whether the same advantages associated with the DAA could be attained in patients undergoing simultaneous bilateral THA.
METHODS: We retrospectively reviewed 89 patients who underwent one-stage bilateral THA through the DAA (group A, n = 46) and through the PA (group B, n = 43) between June 2015 and November 2017 at our institution. The patients were followed up for a minimum of 1 year. There were no significant differences in gender, age, body mass index (BMI), preoperative hemoglobin level, preoperative Harris hip score (HHS), and preoperative visual analogue scale (VAS) score between the two groups (P > 0.05 for all).
RESULTS: The incision length, operation time, intraoperative blood loss, blood transfusion volume, and the length of stay (LOS) were significantly less in group A than in group B (p < 0.05). The surgery-related complications were not significantly lower in group A (5.43%) than in group B (10.47%) (χ2 = 2.209, p = 0.112). In 46 cases in group A, one hip had an acetabular anteversion higher than normal value. In both groups, one hip developed aseptic loosening. The HHS was significantly higher in group A than in group B 1, 3, 12 month(s) after operation (p < 0.05). The VAS was significantly lower in group A than in group B 1, 3, 12 month(s) after operation. Against the simple Likert scale, comprehensive satisfaction was significantly higher in group A (97.8%, 45/46) than in group B (76.7%, 33/43) (χ2 = 9.119, p = 0.003).
CONCLUSIONS: In patients who underwent simultaneous bilateral THA, DAA could significantly relieve pain, accelerate the functional recovery of hip joint and improve the satisfaction more than PA. In clinical practice, however, more attention should be paid to strict compliance to operative indications and the prevention of early complications. The long-term effectiveness warrants further observation.
METHODS: We retrospectively reviewed 89 patients who underwent one-stage bilateral THA through the DAA (group A, n = 46) and through the PA (group B, n = 43) between June 2015 and November 2017 at our institution. The patients were followed up for a minimum of 1 year. There were no significant differences in gender, age, body mass index (BMI), preoperative hemoglobin level, preoperative Harris hip score (HHS), and preoperative visual analogue scale (VAS) score between the two groups (P > 0.05 for all).
RESULTS: The incision length, operation time, intraoperative blood loss, blood transfusion volume, and the length of stay (LOS) were significantly less in group A than in group B (p < 0.05). The surgery-related complications were not significantly lower in group A (5.43%) than in group B (10.47%) (χ2 = 2.209, p = 0.112). In 46 cases in group A, one hip had an acetabular anteversion higher than normal value. In both groups, one hip developed aseptic loosening. The HHS was significantly higher in group A than in group B 1, 3, 12 month(s) after operation (p < 0.05). The VAS was significantly lower in group A than in group B 1, 3, 12 month(s) after operation. Against the simple Likert scale, comprehensive satisfaction was significantly higher in group A (97.8%, 45/46) than in group B (76.7%, 33/43) (χ2 = 9.119, p = 0.003).
CONCLUSIONS: In patients who underwent simultaneous bilateral THA, DAA could significantly relieve pain, accelerate the functional recovery of hip joint and improve the satisfaction more than PA. In clinical practice, however, more attention should be paid to strict compliance to operative indications and the prevention of early complications. The long-term effectiveness warrants further observation.
摘要：
目的：与后路（PA）相比，直接前入路（DAA）可以获得更好的临床效果。这项研究的目的是调查同时接受双侧THA的患者是否可以获得与DAA相关的相同优势。
方法：我们回顾性分析了89例通过DAA进行一期双侧THA的患者（A组，n=46)和通过PA(B组，n=43)2015年6月至2017年11月在我们机构。对患者进行至少1年的随访。性别差异不显著,年龄,体重指数（BMI），术前血红蛋白水平，术前Harris髋关节评分(HHS),术前视觉模拟评分(VAS)评分(均P>0.05)。
结果：切口长度，操作时间,术中失血,输血量,A组住院时间（LOS）明显少于B组（p<0.05）。手术相关并发症A组(5.43%)低于B组(10.47%)(χ2=2.209,p=0.112)。A组46例,一个髋关节的髋臼前倾高于正常值。在这两组中,一个髋关节出现无菌性松动。术后1、3、12个月A组HHS明显高于B组(p<0.05)。术后1、3、12个月，A组VAS显著低于B组。与简单的李克特量表相比，A组的综合满意度明显高于A组(97.8%，45/46）比B组（76.7％，33/43）（χ2=9.119，p=0.003）。
结论：在同时进行双侧THA的患者中，DAA能明显缓解疼痛,与PA相比，髋关节功能恢复更快，满意度更高。在临床实践中,然而,应更加注意严格遵守手术适应症和预防早期并发症。长期有效性值得进一步观察。
方法：我们回顾性分析了89例通过DAA进行一期双侧THA的患者（A组，n=46)和通过PA(B组，n=43)2015年6月至2017年11月在我们机构。对患者进行至少1年的随访。性别差异不显著,年龄,体重指数（BMI），术前血红蛋白水平，术前Harris髋关节评分(HHS),术前视觉模拟评分(VAS)评分(均P>0.05)。
结果：切口长度，操作时间,术中失血,输血量,A组住院时间（LOS）明显少于B组（p<0.05）。手术相关并发症A组(5.43%)低于B组(10.47%)(χ2=2.209,p=0.112)。A组46例,一个髋关节的髋臼前倾高于正常值。在这两组中,一个髋关节出现无菌性松动。术后1、3、12个月A组HHS明显高于B组(p<0.05)。术后1、3、12个月，A组VAS显著低于B组。与简单的李克特量表相比，A组的综合满意度明显高于A组(97.8%，45/46）比B组（76.7％，33/43）（χ2=9.119，p=0.003）。
结论：在同时进行双侧THA的患者中，DAA能明显缓解疼痛,与PA相比，髋关节功能恢复更快，满意度更高。在临床实践中,然而,应更加注意严格遵守手术适应症和预防早期并发症。长期有效性值得进一步观察。
