Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, C.T.O. Largo Palagi 1, 50139, Florence, Italy.
Int Orthop. 2019 Jan;43(1):47-53. doi: 10.1007/s00264-018-4190-6. Epub 2018 Oct 4.
The purpose of this study was to evaluate safety, efficacy, and learning curves of anterior-based muscle-sparing total hip arthroplasty (ABMS-THA) in the supine position. Furthermore, early functional outcome was evaluated and compared to direct anterior approach (DAA) by measuring surface electromyography (sEMG).
We present a prospective cohort study of 343 hips. The safety and learning curve were assessed by recording operative time and peri-operative adverse events. For assessment of efficacy, functional and radiological outcomes were evaluated. A selected group of 32 patients have been studied by sEMG and compared to a matched group of 32 patients who received a THA using DAA approach.
There was one dislocation (0.3%); two (0.6%) patients had an intra-operative fractures of the greater trochanter; two patients (0.6%) experienced a self-limited femoral nerve palsy. Physical therapy milestones for hospital discharge were reached on an average of 1.7 days. sEMG showed that ABMS and DAA have a similar muscle recruitment pattern and functional recovery after THA. One patient was revised for infection, 16 were lost, and 326 hips were available with a median follow-up of 42 months (range 24-60). The mean Harris Hip Score (HSS) increased from 44.3 to 91.9. Ninety-six percent of the hips had a leg length discrepancy (LLD) < 5 mm. There were no radiological signs of mechanical loosening or osteolysis.
The ABMS approach in the supine position is clinically effective and safe; special advantages include a very low dislocation rate and a great control of LLD.
本研究旨在评估仰卧位基于前侧肌肉保留的全髋关节置换术（ABMS-THA）的安全性、疗效和学习曲线。此外，通过测量表面肌电图（sEMG）来评估早期功能结果，并与直接前入路（DAA）进行比较。
我们进行了一项前瞻性队列研究，共纳入 343 髋。通过记录手术时间和围手术期不良事件来评估安全性和学习曲线。为了评估疗效，评估了功能和影像学结果。选择了 32 例患者进行 sEMG 研究，并与接受 DAA 治疗的 32 例患者进行匹配比较。
发生 1 例脱位（0.3%）；2 例（0.6%）患者大转子术中骨折；2 例（0.6%）患者出现短暂性股神经麻痹。平均住院 1.7 天达到物理治疗出院标准。sEMG 显示 ABMS 和 DAA 在 THR 后具有相似的肌肉募集模式和功能恢复。1 例患者因感染翻修，16 例失访，326 髋获得中位随访 42 个月（范围 24-60）。Harris 髋关节评分（HHS）从 44.3 增加到 91.9。96%的髋有<5mm 的下肢长度差异（LLD）。无影像学机械松动或骨溶解迹象。
仰卧位基于前侧肌肉保留的全髋关节置换术具有临床有效性和安全性；特别的优势包括非常低的脱位率和很好的控制下肢长度差异。
