Orthopaedic Surgery at the Rothman Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th floor, Philadelphia, PA, 19107, USA,
Int Orthop. 2013 Dec;37(12):2357-62. doi: 10.1007/s00264-013-2093-0. Epub 2013 Sep 26.
It is not clear whether type of surgical approach affects the amount of blood loss in one-stage bilateral total hip arthroplasty (THA). This study therefore aims to examine if type of surgical approach can affect peri-operative blood loss and allogeneic blood transfusion in patients undergoing one-stage bilateral THA.
Records of 319 patients who underwent one-stage bilateral THA from January 2004 to June 2011 were retrospectively reviewed. Patients were divided into two groups: direct anterior (DA) approach (75 patients) and direct lateral (DL) approach (244 patients). Blood loss was calculated using a previously validated formula. Blood loss and need for allogeneic blood transfusion were compared between the two groups. Additionally, the effects of using cell saver and surgical approach were evaluated in a multivariate analysis.
Compared to the DL approach, calculated blood loss was significantly lower in the DA group (2,813.90 ± 804.13 ml vs 3,617.03 ± 1,148.47 ml) and a significantly lower per cent of patients needed allogeneic blood transfusion in the DA group (26.6 vs 52.4%). Intra-operative cell saver was used in 36 patients. Compared to the non-cell saver group, mean blood loss was significantly higher in the cell saver group (4,061.0 ± 1,285.55 ml vs 3,347.71 ± 1,083.85 ml), whereas the difference between the two groups regarding allogeneic blood transfusion was not statistically significant. The DA approach was an independent predictor of lower peri-operative blood loss and allogeneic blood transfusion while using cell saver was not.
Our results may be explained by the lower extent of muscular dissection performed in the DA approach. Our findings also indicate that intra-operative cell salvage might not be justified in bilateral THA performed expeditiously.
目前尚不清楚手术入路的类型是否会影响一期双侧全髋关节置换术（THA）的出血量。因此，本研究旨在探讨一期双侧 THA 患者的手术入路类型是否会影响围手术期失血量和异体输血。
回顾性分析 2004 年 1 月至 2011 年 6 月期间接受一期双侧 THA 的 319 例患者的病历。患者分为两组：直接前入路（DA）组（75 例）和直接外侧入路（DL）组（244 例）。使用先前验证的公式计算失血量。比较两组间失血量和异体输血需求。此外，还通过多变量分析评估了使用细胞回收器和手术入路的影响。
与 DL 入路相比，DA 组的计算失血量明显较少（2,813.90 ± 804.13 ml 比 3,617.03 ± 1,148.47 ml），DA 组需要异体输血的患者比例也明显较低（26.6%比 52.4%）。36 例患者术中使用了细胞回收器。与非细胞回收器组相比，细胞回收器组的平均失血量明显较高（4,061.0 ± 1,285.55 ml 比 3,347.71 ± 1,083.85 ml），但两组间异体输血的差异无统计学意义。DA 入路是围手术期低出血量和异体输血的独立预测因素，而使用细胞回收器则不是。
我们的结果可以解释为 DA 入路中肌肉解剖范围较小。我们的发现还表明，在快速进行双侧 THA 时，术中细胞回收可能没有道理。
