全髋关节置换术中微创直接前路入路联合大头假体——脱位仍是主要问题吗？一项病例对照研究。
The minimal invasive direct anterior approach in combination with large heads in total hip arthroplasty - is dislocation still a major issue? a case control study.
作者信息
Hoell Steffen, Sander Marius, Gosheger Georg, Ahrens Helmut, Dieckmann Ralf, Hauschild Gregor
机构信息
Center of arthroplasty and revision arthroplasty, Department of General Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Muenster, Germany.
出版信息
BMC Musculoskelet Disord. 2014 Mar 12;15:80. doi: 10.1186/1471-2474-15-80.
BACKGROUND
There have been increasing numbers of publications in recent years on minimally invasive surgery (MIS) for total hip arthroplasty (THA), reporting results with the use of different head sizes, tribologic and functional outcomes. This study presents the results and early complication rates after THA using the direct anterior approach (DAA) in combination with head sizes ≥ 36 mm.
METHODS
A total of 113 patients with THA were included in the study. The Harris Hip Score (HHS) was determined, a radiographic evaluation was carried out, and complications were recorded. The minimum follow-up period was 2 years (means 35 ± 7 months).
RESULTS
The HHS improved from 43.6 (± 12) to 88.2 (± 14; P < 0.01). One early infection occurred, one periprosthetic fracture, and three cases of aseptic stem loosening. No incorrect positioning of the implants was observed, and there were no dislocations.
CONCLUSION
THA with the minimally invasive DAA in combination with large heads is associated with good to very good functional results in the majority of cases. The complication rates are not increased. The rate of dislocation mainly as an complication of the first two years can be markedly reduced in particular.
背景
近年来，关于全髋关节置换术（THA）的微创手术（MIS）的出版物越来越多，报道了使用不同股骨头尺寸的结果、摩擦学和功能结果。本研究展示了采用直接前路（DAA）并结合≥36mm股骨头尺寸进行THA后的结果和早期并发症发生率。
方法
本研究共纳入113例行THA的患者。测定Harris髋关节评分（HHS），进行影像学评估，并记录并发症。最短随访期为2年（平均35±7个月）。
结果
HHS从43.6（±12）提高到88.2（±14；P<0.01）。发生1例早期感染、1例假体周围骨折和3例无菌性柄松动。未观察到植入物位置不当，也未发生脱位。
结论
采用微创DAA并结合大尺寸股骨头进行THA，在大多数情况下可获得良好至非常好的功能结果。并发症发生率没有增加。尤其是前两年作为主要并发症的脱位率可显著降低。
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