Berstock J R, Blom A W, Beswick A D
North Bristol NHS Trust, UK.
Ann R Coll Surg Engl. 2015 Jan;97(1):11-6. doi: 10.1308/003588414X13946184904008.
Total hip arthroplasty is one of the most commonly performed orthopaedic procedures. Despite this, medical evidence to inform the choice of surgical approach is lacking. Currently in the UK, the two most frequently performed approaches to the hip are the posterior and the direct lateral.
This systematic review was performed according to Cochrane guidelines following an extensive search for prospective controlled trials published in any language before January 2014. Of the 728 records identified from searches, 6 prospective studies (including 3 randomised controlled trials) involving 517 participants provided data towards this review.
Compared with the lateral approach, the posterior approach conferred a significant reduction in the risk of Trendelenburg gait (odds ratio [OR]: 0.31, p=0.0002) and stem malposition (OR: 0.24, p=0.02), and a non-significant reduction in dislocation (OR: 0.37, p=0.16) and heterotopic ossification (OR: 0.41, p=0.13). Neither approach conferred a functional advantage. We draw attention to the paucity of evidence and the need for a further randomised trial.
全髋关节置换术是最常施行的骨科手术之一。尽管如此，目前仍缺乏指导手术入路选择的医学证据。目前在英国，最常采用的两种髋关节手术入路是后入路和直接外侧入路。
本系统评价按照Cochrane指南进行，广泛检索了2014年1月之前以任何语言发表的前瞻性对照试验。从检索到的728条记录中，6项前瞻性研究（包括3项随机对照试验）涉及517名参与者，为本次评价提供了数据。
与外侧入路相比，后入路显著降低了臀中肌步态风险（比值比[OR]：0.31，p = 0.0002）和假体柄位置异常风险（OR：0.24，p = 0.02），脱位（OR：0.37，p = 0.16）和异位骨化（OR：0.41，p = 0.13）风险降低但无统计学意义。两种入路均未显示出功能优势。我们提请注意证据的匮乏以及进一步开展随机试验的必要性。
