Yao Reina, Howard James L, Lanting Brent A
Orthopedics. 2017 Nov 1;40(6):e971-e974. doi: 10.3928/01477447-20170918-05. Epub 2017 Sep 22.
The direct anterior (DA) approach for total hip arthroplasty (THA) has become increasingly popular. However, femoral access can be more technically challenging in difficult cases as compared with other approaches. Conjoint tendon release can improve proximal femoral exposure, but its effect on patient function and pain has not been studied. This study evaluated the effect of conjoint tendon release on length of stay (LOS), inpatient pain medication requirements, and functional outcomes of patients undergoing DA THA. The authors retrospectively reviewed charts of all primary DA THAs conducted by a single surgeon between August 2012 and July 2015. Patient demographics, bilateral THA cases, intraoperative conjoint tendon or other soft tissue releases, intraoperative complications, LOS, and inpatient pain medication data were evaluated. One-year functional outcome scores, including the Western Ontario and McMaster Universities Osteoarthritis Index and the Harris Hip Scores, were also reviewed. The authors identified 312 primary DA THAs, with 29 concurrent bilateral THAs. The conjoint tendon was released in 180 cases, whereas a tensor fascia lata (TFL) was released for 29 cases. Mean LOS was 1.3±1.1 days, with patient age (P=.002), bilateral THA (P<.001), TFL release (P=.005), and intraoperative complications (P=.002) predictive of LOS. Mean daily morphine equivalent dose narcotic use was 43.2±48.2 mg, with age being a negative predictor of narcotic use (P=.019). Conjoint tendon release was not predictive of LOS, inpatient pain medication requirements, or outcome scores. Given that conjoint release improves femoral exposure but does not affect LOS or 1-year patient-reported outcomes, intraoperative thresholds for conjoint release should be low. [Orthopedics. 2017; 40(6):e971-e974.].
全髋关节置换术（THA）的直接前路（DA）入路越来越受欢迎。然而，与其他入路相比，在困难病例中股骨入路在技术上可能更具挑战性。联合肌腱松解可改善股骨近端暴露，但尚未研究其对患者功能和疼痛的影响。本研究评估了联合肌腱松解对接受DA THA患者的住院时间（LOS）、住院期间止痛药物需求及功能结局的影响。作者回顾性分析了2012年8月至2015年7月期间由一名外科医生实施的所有初次DA THA病例的病历。评估了患者人口统计学资料、双侧THA病例、术中联合肌腱或其他软组织松解情况、术中并发症、LOS及住院期间止痛药物数据。还回顾了1年功能结局评分，包括西安大略和麦克马斯特大学骨关节炎指数以及Harris髋关节评分。作者确定了312例初次DA THA，其中29例为同期双侧THA。180例患者进行了联合肌腱松解，29例患者进行了阔筋膜张肌（TFL）松解。平均LOS为1.3±1.1天，患者年龄（P = 0.002）、双侧THA（P < 0.001）、TFL松解（P = 0.005）及术中并发症（P = 0.002）可预测LOS。平均每日吗啡等效剂量的麻醉药物使用量为43.2±48.2 mg，年龄是麻醉药物使用的负性预测因素（P = 0.019）。联合肌腱松解不能预测LOS、住院期间止痛药物需求或结局评分。鉴于联合松解可改善股骨暴露，但不影响LOS或1年患者报告结局，术中联合松解的阈值应较低。[《骨科》。2017；40(6):e971 - e974。]
