使用直接前路与直接外侧入路行初次全髋关节置换术中的异位骨化
Heterotopic Ossification in Primary Total Hip Arthroplasty Using the Direct Anterior vs Direct Lateral Approach.
作者信息
Alijanipour Pouya, Patel Ripal P, Naik Tejal U, Parvizi Javad
机构信息
Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
出版信息
J Arthroplasty. 2017 Apr;32(4):1323-1327. doi: 10.1016/j.arth.2016.11.030. Epub 2016 Nov 22.
BACKGROUND
The formation and severity of heterotopic ossification (HO) may be influenced by type of surgical approach. Our hypothesis was that because of differences in soft tissue dissection, differences exist in HO formation in primary total hip arthroplasty using direct anterior (DA) vs direct lateral (DL) approach.
METHODS
A total of 1482 consecutive patients with DL (736) or DA (746) approach and similar perioperative care protocol during 2009-2011 were retrospectively studied. No patient received prophylactic radiotherapy. Preoperative and 6-month postoperative radiographs were reviewed based on Brooker classification.
RESULTS
The incidence of overall HO was higher in DL (36.1%) vs DA group (19.4%, P < .001) but high-grade HO (Brooker ≥3) was not significantly different among the groups (3.9% for DL and 3.0% for DA groups). No patient required further surgery for HO resection.
CONCLUSION
The type of approach (DA vs DL) did not seem to have a major influence on the short-term incidence of high-grade HO based on this radiographic analysis.
背景
异位骨化（HO）的形成及严重程度可能受手术入路类型的影响。我们的假设是，由于软组织解剖的差异，在初次全髋关节置换术中采用直接前路（DA）与直接外侧（DL）入路时，HO的形成存在差异。
方法
回顾性研究了2009年至2011年间连续接受DL（736例）或DA（746例）入路且围手术期护理方案相似的1482例患者。无一例患者接受预防性放疗。根据布鲁克分类法对术前和术后6个月的X线片进行评估。
结果
DL组总体HO发生率（36.1%）高于DA组（19.4%，P <.001），但两组间高级别HO（布鲁克≥3级）无显著差异（DL组为3.9%，DA组为3.0%）。无一例患者因HO切除需要进一步手术。
结论
基于此项影像学分析，手术入路类型（DA与DL）似乎对高级别HO的短期发生率没有重大影响。
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