Orthopedic Department, Schulthess Clinic, Zurich, Switzerland.
University of Rochester School of Medicine, Rochester, New York, USA.
Bone Joint J. 2018 Jul;100-B(7):853-861. doi: 10.1302/0301-620X.100B7.BJJ-2017-1200.R2.
The classical longitudinal incision used for the direct anterior approach (DAA) to the hip does not follow the tension lines of the skin and can lead to impaired wound healing and poor cosmesis. The purpose of this retrospective study was to determine the satisfaction with the scar, and functional and radiographic outcomes comparing the classic longitudinal incision with a modified skin crease 'bikini' when the DAA is used for total hip arthroplasty (THA).
A total of 964 patients (51% female; 59% longitudinal, 41% 'bikini') completed a follow-up questionnaire between two and four years postoperatively, including the Oxford Hip Score (OHS), the University of North Carolina '4P' scar scale (UNC4P) and two items for assessing the aesthetic appearance of the scar and symptoms of numbness. The positioning of the components, rates of heterotopic ossification (HO) and rates of revision were assessed.
The mean OHS was similar in both groups (p = 0.41). The mean UNC4P total score was slightly better (p = 0.01) and the proportion of patients who were very satisfied with the cosmetic aspects of the scar was higher in the 'bikini' group (p < 0.001). The proportion of patients reporting numbness in the scar was higher in the longitudinal group (14.5% vs 7.5%, respectively, p < 0.001). The abduction angle of the acetabular component, the position of the stem and rates of HO did not differ between the groups. There were no differences in the revision rates of both groups, being 2.3% in the longitudinal and 1.5% in the 'bikini' group (p = 0.911).
We found that a short oblique 'bikini' skin crease incision is safe when used for the DAA at THA, without compromising the positioning of the components or increasing the rate of lateral femoral cutaneous nerve dysaesthesia. Although it leads to a superior scar satisfaction, as it is less extensile, it should be used after having gained experience with the classic longitudinal incision. Cite this article: Bone Joint J 2018;100-B:853-61.
髋关节直接前入路（DAA）中使用的经典纵行切口不遵循皮肤的张力线，可能导致伤口愈合不良和美容效果不佳。本回顾性研究的目的是比较 DAA 行全髋关节置换术（THA）时经典纵行切口与改良皮纹“比基尼”切口的患者对疤痕、功能和影像学结果的满意度。
964 例患者（51%为女性；59%为纵行切口，41%为“比基尼”切口）在术后 2 至 4 年完成了随访问卷调查，包括牛津髋关节评分（OHS）、北卡罗来纳大学“4P”疤痕量表（UNC4P）和 2 项评估疤痕美观和麻木症状的项目。评估了假体的位置、异位骨化（HO）发生率和翻修率。
两组 OHS 平均值相似（p = 0.41）。改良皮纹“比基尼”切口组的 UNC4P 总分略好（p = 0.01），对疤痕美容效果非常满意的患者比例更高（p < 0.001）。报告疤痕麻木的患者比例在纵行切口组更高（分别为 14.5%和 7.5%，p < 0.001）。髋臼假体的外展角、柄的位置和 HO 发生率在两组间无差异。两组的翻修率也无差异，纵行切口组为 2.3%，改良皮纹“比基尼”切口组为 1.5%（p = 0.911）。
我们发现，在 DAA 行 THA 时，使用短斜“比基尼”皮纹切口是安全的，不会影响假体的位置或增加股外侧皮神经感觉异常的发生率。尽管它导致更好的疤痕满意度，但由于其延展性较差，应在有使用经典纵行切口的经验后使用。
Bone Joint J. 2018;100-B:853-61.
