Boettner Friedrich, Zingg Matthieu, Emara Ahmed K, Waldstein Wenzel, Faschingbauer Martin, Kasparek Maximilian F
Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York.
Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Genève 14, Switzerland.
J Arthroplasty. 2017 Apr;32(4):1180-1185. doi: 10.1016/j.arth.2016.10.004. Epub 2016 Oct 12.
This study compares the differences in acetabular component position, leg length discrepancy, and hip offset between the anterior and posterior approach. A novel method is applied to determine the acetabular anteversion using the C-arm tilt angle for the anterior approach.
Hundred consecutive anterior total hip arthroplasties were matched according to gender, body mass index, and age to a cohort of 100 primary total hip arthroplasties operated on through a posterior approach. Postoperative radiographs were analyzed to determine cup inclination, cup anteversion, leg length discrepancy, and hip offset.
The mean inclination was 40.8° (range 33°-48°) and 45.1° (range 33°-55°) for the anterior and posterior approach, respectively. Using the new C-arm tilt plane technique, an average acetabular anteversion of 18.4° (range 11°-26°) was achieved with the anterior approach compared with 23.6° (range 8°-38°) with the posterior approach. Hundred percent cups in the anterior group and 81% in the posterior group fell within the safe zone (P < .001). There was no difference in the overall hip offset between the operated side and the contralateral side for the anterior (P = .074) and posterior (P = .919) group. There was no difference in leg length discrepancy between the 2 approaches (P = .259).
Intraoperative fluoroscopy-assisted direct anterior approach was associated with improved acetabular component positioning. However, no benefit was shown with regards to restoration of hip offset or leg length.
本研究比较了前路和后路手术在髋臼假体位置、肢体长度差异和髋关节偏移方面的差异。一种新方法被应用于通过C型臂倾斜角度来确定前路手术时髋臼的前倾角。
根据性别、体重指数和年龄，将连续100例前路全髋关节置换术与100例通过后路进行的初次全髋关节置换术进行匹配。分析术后X线片以确定髋臼倾斜度、髋臼前倾角、肢体长度差异和髋关节偏移。
前路和后路手术的平均倾斜度分别为40.8°（范围33°-48°）和45.1°（范围33°-55°）。采用新的C型臂倾斜平面技术，前路手术的髋臼平均前倾角为18.4°（范围11°-26°），而后路手术为23.6°（范围8°-38°）。前路组100%的髋臼杯和后路组81%的髋臼杯落在安全区内（P <.001）。前路组（P = 0.074）和后路组（P = 0.919）手术侧与对侧的总体髋关节偏移无差异。两种手术方法在肢体长度差异方面无差异（P = 0.259）。
术中透视辅助下的直接前路手术与改善髋臼假体定位相关。然而，在恢复髋关节偏移或肢体长度方面未显示出益处。
