Kunkel Samuel T, Sabatino Matthew J, Kang Ravinder, Jevsevar David S, Moschetti Wayne E
Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.
Eur J Orthop Surg Traumatol. 2018 Feb;28(2):217-232. doi: 10.1007/s00590-017-2033-6. Epub 2017 Aug 29.
We performed a systematic review and meta-analysis to assess whether the direct anterior approach (DAA) is associated with improved functional and clinical outcomes compared to other surgical approaches for hemiarthroplasty for displaced femoral neck fractures.
Randomized trials and cohort studies of hemiarthroplasty performed via DAA versus another surgical approach (anterolateral, lateral, posterolateral, posterior) were included. Our primary outcome was postoperative functional mobility. Secondary outcomes included overall complication rate, dislocation rate, perioperative fracture, infection rate, re-operation rate, overall mortality, operative time, pain, intra-operative blood loss, and length of stay.
Nine studies met inclusion criteria, comprising a total of 698 hips (330 direct anterior, 57 anterolateral, 89 lateral, 114 posterolateral, 108 posterior approach). With regard to functional mobility, DAA was favored in 4 studies, and no study favored another approach over DAA. DAA had a significantly lower dislocation rate compared to posterior capsular approaches. Analysis of other secondary outcomes did not identify statistically significant differences.
This is the first systematic review and meta-analysis of the DAA for hemiarthroplasty. Available evidence suggests superior early functional mobility with the DAA. The DAA is associated with a significantly lower dislocation rate compared to posterior capsular approaches for hemiarthroplasty.
我们进行了一项系统评价和荟萃分析，以评估与其他用于移位型股骨颈骨折半髋关节置换术的手术入路相比，直接前路（DAA）是否能带来更好的功能和临床结果。
纳入通过DAA与另一种手术入路（前外侧、外侧、后外侧、后侧）进行半髋关节置换术的随机试验和队列研究。我们的主要结局是术后功能活动度。次要结局包括总体并发症发生率、脱位率、围手术期骨折、感染率、再次手术率、总体死亡率、手术时间、疼痛、术中失血量和住院时间。
9项研究符合纳入标准，共纳入698例髋关节（330例直接前路、57例前外侧、89例外侧、114例后外侧、108例后侧入路）。在功能活动度方面，4项研究支持DAA，没有研究表明其他入路优于DAA。与后关节囊入路相比，DAA的脱位率显著更低。对其他次要结局的分析未发现统计学上的显著差异。
这是第一项关于DAA用于半髋关节置换术的系统评价和荟萃分析。现有证据表明DAA具有更好的早期功能活动度。与用于半髋关节置换术的后关节囊入路相比，DAA的脱位率显著更低。
