Oba Takayoshi, Inaba Yutaka, Saito Izumi, Fujisawa Takahiro, Saito Tomoyuki
Department of Orthopaedic Surgery, Shin-Yurigaoka General Hospital, 255 Furusawatuko, Asao-ku, Kawasaki, Kanagawa, 215-0026, Japan.
Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
J Orthop Sci. 2018 Nov;23(6):977-981. doi: 10.1016/j.jos.2018.07.003. Epub 2018 Aug 4.
The use of direct anterior approach (DAA) for hemiarthroplasty in femoral neck fracture patients has recently increased worldwide. However, no previous studies have elucidated or validated risk factors for prolonged operative time in hemiarthroplasty through DAA. Accurately predicting operative time would contribute to and the selection of the most appropriate surgical approach for each patient and the effective use of operating room.
Data from 151 femoral neck fracture patients who underwent hemiarthroplasty through DAA were evaluated. A multiple linear regression model of the operative time of hemiarthroplasty was developed, including age, sex, body mass index (BMI), surgeons' DAA experience and approach depth (cm) on the axial computed tomography (CT) slice of the hip as independent factors.
Mean age at admission was 83.8 [±6.3 standard deviation (SD)] years and mean operative time was 93.1 (±21 SD) min. Operative time increased by 20 min for every 1 cm increase in approach depth [partial regression coefficient (B), 20.4; standardized partial regression coefficient (β), 0.68; p < 0.001] and increased 13 min when the DAA was performed by a surgeon with DAA experience of <20 cases (B, 13.1; β, 0.29; p < 0.001). The adjusted R of the model was 0.57.
We demonstrated that increased approach depth and surgeons' DAA experience (<20 cases) are novel risk factors for prolonged operative time in femoral neck fracture patients undergoing hemiarthroplasty through DAA. Surgeons should consider these factors when estimating the operative time of surgery and selecting the most appropriate and safe surgical approach for a patient undergoing hemiarthroplasty.
在全球范围内，股骨颈骨折患者半髋关节置换术中直接前路入路（DAA）的使用近来有所增加。然而，此前尚无研究阐明或验证通过DAA进行半髋关节置换术时手术时间延长的危险因素。准确预测手术时间将有助于为每位患者选择最合适的手术入路，并有效利用手术室。
对151例行DAA半髋关节置换术的股骨颈骨折患者的数据进行评估。建立了半髋关节置换术手术时间的多元线性回归模型，纳入年龄、性别、体重指数（BMI）、外科医生的DAA经验以及髋关节轴向计算机断层扫描（CT）切片上的入路深度（厘米）作为独立因素。
入院时的平均年龄为83.8[±6.3标准差（SD）]岁，平均手术时间为93.1（±21 SD）分钟。入路深度每增加1厘米，手术时间增加20分钟[偏回归系数（B），20.4；标准化偏回归系数（β），0.68；p<0.001]，当由DAA经验<20例的外科医生进行DAA时，手术时间增加13分钟（B，13.1；β，0.29；p<0.001）。该模型的调整R为0.57。
我们证明，入路深度增加和外科医生的DAA经验（<20例）是行DAA半髋关节置换术的股骨颈骨折患者手术时间延长的新危险因素。外科医生在估计手术时间并为行半髋关节置换术的患者选择最合适、最安全的手术入路时应考虑这些因素。
