| Objective:1.To avoid doing harm to lateral femoral cutaneous nerve during clinical surgery,the relationship between direct anterior approach(DAA)and lateral femoral cutaneous nerve is studied by an autopsy study.The sagittal balances of spine and pelvis after DAA/PLA total hip replacement are compared by measuring parameters of sagittal balances of spine and pelvis in a handful of patients with hip osteoarthritis.2.With the clinical investigation on the treatment of femoral head necrosis,hip osteoarthritis and femoral neck fracture by DAA total hip replacement(THR)and posterolateral approach(PLA)THR,the differences between DAA and PLA are evaluated under the principle of parallel contrast between the two groups,and the treatment scheme of THR was formed,which could be popularized and applied.3.Recessive Blood Loss(HBL),the most common complication in the perioperative period of total hip replacement,Si Wu decoction was selected to intervene HBL in the patients after THR in order to observe the advantages of traditional Chinese medicine in treating and preventing the complication after THR.Methods:(1)Seven cadavers of lower limbs were collected from Department of Anatomy and Research,the second people’s Hospital of Changzhou City.male 4 cases.The lateral femoral cutaneous nerve and its surrounding anatomical structure were dissected from the cadaveric specimen,and a parallel ischium was made at the apex of the great trochanter of the specimen.The horizontal line of the segmental line is X,a horizontal line parallel to the line of ischial nodule is made at the base of the small thick protuberance,and a horizontal line is made between X ray and Z line parallel to two straight lines.Each branch of the lateral femoral cutaneous nerve was marked with three straight lines.The direct anterior incision was made along the anterior superior iliac spine 2cm and the lateral 2cm along the fibula head.The distance between each intersection point and the incision line was calculated respectively.(2)From January 2015 to March 2015,10 patients with hip osteoarthritis treated with THA in orthopedics and trauma department of Changzhou Traditional Chinese Medicine Hospital are divided into DAA and PLA group according to the operative method,5 for each.The parameters of sagittal balances of spine and pelvis are compared before and after THA.(3)From March 2015 to March 2017,80 patients treated with THA in orthopedics and trauma department of Changzhou Traditional Chinese Medicine Hospital are divided into DAA and PLA group according to the operative method,40 for each.The length of surgical incision in two groups,operation time,intraoperative bleeding volume,postoperative drainage flow,difference of hemoglobin before and after operation,postoperative ESR-CRP and time of getting out of bed are recorded and analyzed.All patients receive VAS evaluation before and 3 days,1 week,4 weeks and 8 weeks after operation.Both groups receive Harris score before and 1 month,3 months,6months after operation.The thoracic kyphosis angle,lumbar kyphosis angle,pelvic incidence angle,pelvic oblique angle and sacral obliquity angle are measured and compared before and after operation in patients with femoral head necrosis,hip osteoarthritis and femoral neck fracture.(4)20 cases are randomly selected as treatment group and 20 cases as control group,20 cases are randomly selected from PLA group as treatment group,and the other 20 cases are taken as control group.DAA group and PLA group are not compared.The control group receives routine treatment after operation,and the treatment group receives routine treatment after the operation plus Si Wu decoction.Hct and Hb are recorded and compared 1day before operation and 3 days,7 days,10 days after operation in both groups.Results:①The length of the surgical incision,the first time leaving bed after operation,the amount of bleeding in the operation,the drainage after operation,ESR and CRP in 2 days after operation,d-value of Hb before and after operation in DAA group are superior to those in PLA group,but the length of operation in DAA group is inferior to that in PLA group,the difference between two groups has significant statistical significance(P<0.001).②There is no significant statistical difference between two groups in imaging results(P>0.05).③ In the intra-group comparison of Harris scores,there are significant differences in both DAA and PLA groups before operation and 1 month,3months,6 months,lyear after operation(P<0.001).In the inter-group comparison,the Harris score in 1 month and 3 months after opration in DAA group are superior to those in PLA group,the difference between two groups has significant statistical significance(P<0.05);there is no significant statistical difference between two groups in Harris score in 1 month and 3 months after operation.④In the intra-group comparison of VAS,there are significant differences in both DAA and PLA groups before operation and 3days,1 week,4weeks and 8 weeks after operation(P<0.001).In the inter-group comparison,the Harris score in 1 week,4 weeks and 8 weeks after opration in DAA group are superior to those in PLA group,the difference between two groups has significant statistical significance(P<0.05);⑤ In the patients with hip osteoarthritis,there is no significant difference in TK and PI(P>0.05),while there are significant differences between LL,SS and PT before and after operation in DAA group(P<0.05).There is no significant difference in TK and PI(P>0.05),while there are significant differences between LL,SS and PT before and after operation in PLA group(P<0.05).In the inter-comparision,there are significant differences in LL,SS and PT(P<0.05)),while there is no significant differences in TK and PI between two groups.In the patients with femoral neck fractures,there is no significant difference in TK,PI,LL,SS,PT in inter-group and in tra-group comparision in both groups(P>0.05).In the patients with osteonecrosis of the femeral head,there is no significant difference in TK,LL and PI(P>0.05),while there are significant differences between SS and PT before and after operation in both groups(P<0.05).In the inter-comparision,there is no significant difference in TK,PI,LL,SS,PT between two groups(P>0.05).⑥ Hct and Hb in treatment group of both groups show no significant difference 1 day before operation(P>0.05),but show significant differences 3,7,10 days after operation comparing to relative control group(P<0.05).Conclusion:(1)The injury of lateral femoral cutaneous nerve occurred during direct anterior approach hip arthroplasty,most of which were the lateral branch of anterior branch.The lateral and posterior branches of the lateral femoral cutaneous nerve may be injured if the surgical incision is expanded upward.The lateral and medial branches of the lateral femoral cutaneous nerve could be easily damaged by lengthening the incision.During the operation,the lateral branch of the lateral femoral cutaneous nerve may be damaged if the medial incision is too large.(2)DAA has obvious advantages in the length of the surgical incision,the first time leaving bed after operation,the amount of bleeding in the operation,the drainage after operation,ESR and CRP in 2 days after operation,d-value of Hb before and after operation comparing with PLA,but has a longer length of operation than PLA.Both DAA and PLA can better the function of hips and release pain,but DAA has a better effect on loosing pain and recovering quickly comparing with PLA.Both DAA and PLA can improve the sagittal balance of spine and pelvis in patients with hip osteoarthritis and osteonecrosis of the femeral head,and DAA has a better effect than PLA especially in patients with hip osteoarthritis.(3)Si Wu decoction shows a curative effect in treating HBL after DAA/PLA total hip replacement,which illustrates the advantages of traditional Chinese medicine on treating and preventing HBL. |
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