Department of Orthopedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, China.
Department of Orthopedics, Jingjiang People's Hospital, 28, Zhongzhou East road, Taizhou, China.
BMC Musculoskelet Disord. 2020 Jan 11;21(1):21. doi: 10.1186/s12891-019-3035-9.
The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility.
Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue "pad" created from the anterior capsule of the joint which protect the TFLM from direct contact with the retractors. In group B, the operation was carried out with no protection of the TFLM except the attempt by the surgeons to consciously avoid injury of the TFLM. We evaluated magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at different time, postoperatively. The Harris hip score, postoperative drainage volume and visual analogue scores (VAS) were compared between the two groups.
LDH, CPK and myoglobin in group B were significantly higher than group A at 8, 24, and 48 h after the surgery. (p < 0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 h after surgery. (P < 0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher than group A. (P < 0.05) The Harris score in group A was significantly higher than group B (P < 0.05) one month after surgery, but there was no significant difference six months later.
Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect.
ChiCTR: ChiCTR1900025173. Retrospectively registered August 15, 2019.
全髋关节置换术（THA）的直接前入路具有特定的优势，但股外侧肌（TFLM）的损伤仍然是一个关注点。这种损伤部分否定了肌间入路的一些优势，因为 TFLM 肌纤维的损伤可能导致不太满意的临床结果。因此，在本研究中，我们提出了一种保护 TFLM 的术中方法，并证明了其可行性。
56 例行直接前路 THA 的患者随机分为两组。在 A 组中，通过从关节前囊创建自体组织“垫”来保护 TFLM，以防止 TFLM 与牵开器直接接触。在 B 组中，除了外科医生试图有意识地避免损伤 TFLM 之外，手术没有保护 TFLM。我们通过磁共振成像评估肌肉横截面积（MSCA）和脂肪萎缩（FA）的变化幅度。比较两组患者在不同时间点（术后）的血红蛋白和血清肌红蛋白、乳酸脱氢酶（LDH）和肌酸磷酸激酶（CPK）水平的差异。比较两组患者的 Harris 髋关节评分、术后引流量和视觉模拟评分（VAS）。
B 组的 LDH、CPK 和肌红蛋白在术后 8、24 和 48 小时明显高于 A 组（p<0.05）。与 A 组相比，B 组术后 24 和 48 小时血红蛋白下降明显（p<0.05）。B 组 TFLM 的 MSCA 和 FA 明显增加。B 组 PDV 和 VAS 明显高于 A 组（p<0.05）。术后 1 个月 A 组的 Harris 评分明显高于 B 组（p<0.05），但 6 个月后无明显差异。
在直接前路 THA 中，使用髋关节前囊作为自体保护性囊组织垫来限制 TFLM 的创伤是保护 TFLM 并改善临床效果的有效方法。
ChiCTR：ChiCTR1900025173。回顾性注册于 2019 年 8 月 15 日。
