Nakamura Junichi, Hagiwara Shigeo, Orita Sumihisa, Akagi Ryuichiro, Suzuki Takane, Suzuki Masahiko, Takahashi Kazuhisa, Ohtori Seiji
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan.
Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan.
BMC Musculoskelet Disord. 2017 Jan 31;18(1):49. doi: 10.1186/s12891-017-1427-2.
The purpose of this prospective cohort study was to clarify the safety and efficacy of total hip arthroplasty via the direct anterior approach in the supine position with a novel mobile traction table.
The first experience of consecutive surgeries by a single surgeon using the direct anterior approach with a traction table is described with a two-year follow-up period. Of 121 patients, 100 patients without previous hip surgeries, severe deformity, or cemented implants were divided into two groups comprising the first 50 patients and the second 50 patients.
The implant survival rate was 99% at the two-year follow-up. Revision surgery was required for periprosthetic femoral fracture in one patient. The complication rate possibly related to the traction table was 5% (5 patients): three anterior dislocations, one periprosthetic femoral fracture, and one intraoperative perforation caused by femoral rasping. The complication rate tended to decrease in the second group compared to the first group (4% versus 6%). Mean surgical time (72.0 minutes versus 82.5 min, p = 0.027), rate of allogeneic blood transfusion (2% versus 24%, p = 0.001), and cup alignment in the safe zone (100% versus 88%, p = 0.027) were significantly improved in the second group compared to the first group.
The direct anterior approach with a novel mobile traction table showed a positive learning curve for surgical time, rate of allogeneic blood transfusion, and cup alignment in the safe zone.
这项前瞻性队列研究的目的是阐明采用新型可移动牵引台在仰卧位经直接前路行全髋关节置换术的安全性和有效性。
描述了一位外科医生使用牵引台经直接前路进行连续手术的首次经验，并进行了为期两年的随访。在121例患者中，100例无既往髋关节手术史、严重畸形或骨水泥植入物的患者被分为两组，每组50例，分别为前50例患者和后50例患者。
两年随访时植入物生存率为99%。1例患者因假体周围股骨骨折需要翻修手术。可能与牵引台相关的并发症发生率为5%（5例患者）：3例前脱位、1例假体周围股骨骨折和1例股骨锉磨导致的术中穿孔。与第一组相比，第二组的并发症发生率有下降趋势（4%对6%）。与第一组相比，第二组的平均手术时间（72.0分钟对82.5分钟，p = 0.027）、异体输血率（2%对24%，p = 0.001）以及髋臼在安全区内的对线情况（100%对88%，p = 0.027）均有显著改善。
采用新型可移动牵引台的直接前路在手术时间、异体输血率和髋臼在安全区内的对线方面显示出积极的学习曲线。
