Molenaers Ben, Driesen Ronald, Molenaers Guy, Corten Kristoff
Department of Orthopaedic Surgery, University Hospitals Leuven-Pellenberg, Leuven, Belgium; Department of Orthopaedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
Department of Orthopaedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
J Arthroplasty. 2017 May;32(5):1553-1559. doi: 10.1016/j.arth.2016.12.016. Epub 2016 Dec 22.
The direct anterior approach on a regular operating room table has been reported with low dislocation rates. This might be beneficial for complex primary total hip arthroplasty (THA) such as in patients with cerebral palsy or following femoral or pelvic osteotomies. Extending the approach is often required to overcome problems such as acetabular deformities or severe contractures.
We retrospectively evaluated the results and complications of 29 patients with 37 complex primary THA in which an extensile approach was used. The extensile approach is described. Functional scores were collected in case the patient was ambulatory independently (n = 17).
The average age was 35 years (range 15-85) with a mean follow-up of 39 months (range 12-60). There were 3 (8%) intra-operative and 4 (11%) early post-operative complications (<3 months), of which 3 (8%) were anterior dislocations. Late complications (>3 months) consisted of a fibrous ingrown stem, a socket loosening following a pelvic fracture, and a late hematogenous infection (8%). Seventy-one percent of the complications occurred in the first 18 cases (49%) indicating a learning curve. The mean post-operative Harris Hip Score was 79 (range 56-97).
Complex THA can be safely conducted through the extensile anterior approach on a regular operating room table with the use of conventional implants, even in cases with a high risk of dislocation.
据报道，在常规手术台上采用直接前路入路全髋关节置换术（THA）的脱位率较低。这对于复杂的初次全髋关节置换术可能有益，例如脑瘫患者或股骨或骨盆截骨术后的患者。通常需要扩大入路以克服髋臼畸形或严重挛缩等问题。
我们回顾性评估了29例患者行37例复杂初次全髋关节置换术并采用扩大入路的结果及并发症情况。描述了扩大入路方法。对于能够独立行走的患者（n = 17）收集功能评分。
平均年龄为35岁（范围15 - 85岁），平均随访39个月（范围12 - 60个月）。术中并发症有3例（8%），术后早期并发症（<3个月）有4例（11%），其中3例（8%）为前脱位。晚期并发症（>3个月）包括纤维组织长入柄、骨盆骨折后髋臼杯松动以及晚期血源性感染（8%）。71%的并发症发生在前18例患者（49%）中，提示存在学习曲线。术后Harris髋关节评分平均为79分（范围56 - 97分）。
即使在脱位风险较高的情况下，复杂全髋关节置换术也可通过常规手术台上的扩大前路入路安全实施，并使用传统植入物。
