目的 分析采用直接前侧入路组（DAA）和髋关节后侧入路组（Moore入路）行髋关节置换术（THA）治疗酒精性股骨头缺血性坏死的疗效差异。方法 前瞻性研究于2018年1月至2020年11月在通辽市医院骨科行THA治疗的酒精性股骨头缺血坏死病例。符合纳入排除标准的病例入选后，用随机数字表法分为手术入路不同的2组：DAA入路组、Moore入路组。比较2组患者年龄、性别构成、所患基础疾病情况。用t检验比较2组患者的手术时长，秩和检验比较2组患者的术中出血量、髋关节Harris评分、美国特种外科医院（HSS）髋关节评分、Kawamura髋臼影像学评价。结果 DAA组纳入29例、Moore组纳入28例研究对象，2组患者的年龄、性别构成、罹患基础疾病情况差异无统计学意义（均为P>0.05）。手术时长DAA组（86±12）min与Moore入路组（90±7）min相近（t=-1.514，P>0.05）；术中出血量DAA组100（100，150）ml比Moore组150（100，200）ml更少（Z=-2.465，P<0.05）。术后9个月评价2组患者的髋关节Harris评分（Z=-0.685）、HSS评分（Z=-0.751）、Kawamura髋臼影像学评估（Z=-0.384）均较为接近（均为P>0.05）。术后随访期间，DAA组未发生人工髋关节脱位；Moore入路组有2例出现人工髋关节后脱位，分别于术后1.5月、4月发生，予以牵引复位、保守治疗，随访期间未再发人工髋关节脱位。结论 对于酒精性股骨头缺血坏死行THA术的患者，采用DAA入路比采用Moore入路可以有效降低术中出血，DAA入路与Moore入路在手术时长、中期髋关节功能恢复方面基本一致。

Objective To analyze the difference in the efficacy of hip arthroplasty (THA) in the treatment of alcohol-induced avascular necrosis of the femoral head using the direct anterior approach (DAA) and the posterior approach of the hip (Moore approach). Methods A prospective study was conducted on the cases of alcoholic avascular necrosis of the femoral head treated with THA in the Department of Orthopedics of our hospital from January 2018 to November 2020. Inclusion criteria: age ≥50 years old, bilateral avascular necrosis of the femoral head, Ficat type IV, unilateral THA, follow-up time of not less than 9 months, and contralateral THA interval of not less than 9 months; excluded Criteria: hip dysplasia, previous hip fracture, liver cirrhosis, paraplegia or paraplegia, tumor, hemophilia, rheumatic immune system disease, syphilis, mental illness, refused to join this study. The random number table method was used to divide the selected subjects into two groups with different surgical approaches: DAA approach group and Moore approach group. The age, gender composition and underlying diseases of the two groups were compared. The t-test was used to compare the operation time of the two groups of patients, and the rank-sum test was used to compare the intraoperative blood loss, Harris hip score, American Hospital for Special Surgery (HSS) hip replacement score, and Kawamura acetabular imaging evaluation. Results There were 29 patients in the DAA group and 28 patients in the Moore group. The age (t=-1.373), gender composition, and underlying diseases of the two groups were basically similar, and the difference was not statistically significant (P>0.05). The operation time of DAA group was (86±12) min and Moore’s approach group (90±7) min was similar, t=-1.514, the difference was not statistically significant (P>0.05); intraoperative blood loss in DAA group was M=100 ( 100, 150) ml was less than Moore group M=150 (100, 200) ml, Z=-2.465, the difference was statistically significant (P<0.05). Nine months after the operation, the Harris hip score (Z=-0.685), HSS score (Z=-0.751), and Kawamura acetabular imaging evaluation (Z=-0.983) of the two groups of patients were similar, and there was no statistical difference. significance (P>0.05). During the postoperative follow-up period, no dislocation of the artificial hip joint occurred in the DAA group; 2 patients in the Moore approach group had posterior dislocation of the artificial hip joint, which occurred 1.5 months and 4 months after the operation, respectively. Dislocation of the artificial hip joint. Conclusion For patients with alcoholic avascular necrosis of the femoral head undergoing THA, DAA approach can effectively reduce intraoperative bleeding than Moore approach. DAA approach and Moore approach are basically the same in terms of operation time and mid-term hip function recovery.

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