Sariali Elhadi, Catonne Yves, Pascal-Moussellard Hugues
Hôpital Pitié Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France.
Laboratoire d'imagerie Biomédicale, 15 rue des cordeliers, 75005, Paris, France.
Int Orthop. 2017 Apr;41(4):699-705. doi: 10.1007/s00264-016-3242-z. Epub 2016 Jun 16.
The direct anterior approach is an attractive option for total hip arthroplasty (THA) in order to achieve a quicker rehabilitation. However, this surgical technique presents a longer learning curve and a higher complications rate compared with the standard approach. We investigated whether three-dimensional (3D) planning anticipated the surgical difficulties and helped to achieve a low complications rate with respect to intra-operative complications, dislocation risk and lower limb discrepancy (LLD).
One hundred and fifty-four consecutive patients underwent a primary cementless THA using a direct anterior approach. A 3D planning was performed in order to anticipate the difficulties that may be encountered regarding femur perforation or fracture, dislocation and LLD. All patients were assessed at a mean five years' follow-up.
No false route and no fracture occurred at the time of surgery. All the surgical difficulties were anticipated. A motorised reaming procedure of the femur was required in six patients because of a very dense bone or a narrow femur. A retroverted neck was used in 7 % of patients because of a torsional abnormality and enabled an increase in stability. The real implant sizes were the same as the ones planned in 97 % for the cup, 96 % for the stem and 100 % for the neck. At five years' follow-up, no dislocation occurred, no patient complained about LLD and excellent clinical outcomes were achieved.
This study demonstrates that 3D pre-operative planning-guided THA through a minimally invasive direct anterior approach is a safe and accurate procedure.
Level IV.
为实现更快康复，直接前路全髋关节置换术（THA）是一种有吸引力的选择。然而，与标准术式相比，这种手术技术学习曲线更长且并发症发生率更高。我们研究了三维（3D）规划是否能预测手术困难，并有助于降低术中并发症、脱位风险和下肢不等长（LLD）方面的并发症发生率。
154例连续患者采用直接前路行初次非骨水泥型THA。进行3D规划以预测在股骨穿孔或骨折、脱位和LLD方面可能遇到的困难。所有患者均在平均5年的随访中接受评估。
手术时未发生错误入路和骨折。所有手术困难均被预测到。6例患者因骨质非常致密或股骨狭窄而需要进行电动股骨扩髓。7%的患者因扭转异常使用了后倾颈，从而提高了稳定性。髋臼杯、股骨柄和股骨头颈的实际植入尺寸与计划尺寸相符的比例分别为97%、96%和100%。在5年随访时，未发生脱位，无患者抱怨LLD，临床效果极佳。
本研究表明，通过微创直接前路进行的3D术前规划引导的THA是一种安全、准确的手术方法。
IV级。
