初次全髋关节置换术中应用后外侧入路与直接外侧入路的异位骨化比较。
Heterotopic ossification in primary total hip arthroplasty using the posterolateral compared to the direct lateral approach.
机构信息
Clinical Orthopedic Research Center, mN, Zeist, The Netherlands.
Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, The Netherlands.
出版信息
Arch Orthop Trauma Surg. 2021 Jul;141(7):1253-1259. doi: 10.1007/s00402-021-03783-6. Epub 2021 Feb 3.
PURPOSE
Total hip arthroplasty (THA) is a successful procedure. However, in time, heterotopic ossification (HO) can form due to, amongst others, soft tissue damage. This can lead to pain and impairment. This study compares the formations of HO between patients who underwent either THA with the posterolateral approach (PA) or with the direct lateral approach (DLA). Our hypothesis is that patients who underwent THA with a PA form less HO compared to THA patients who underwent DLA.
METHODS
In this prospective cohort study, 296 consecutive patients were included who underwent THA. A total of 127 patients underwent THA with the PA and 169 with the DLA. This was dependent on the surgeon's preference and experience. More than 95% of patients had primary osteoarthritis as the primary diagnosis. Clinical outcomes were scored using the Numeric Rating Scale (NRS) and Harris Hip Score (HHS), radiological HO were scored using the Brooker classification. Follow-up was performed at 1 and 6 years postoperatively.
RESULTS
Two hundred and fifty-eight patients (87%) completed the 6-year follow-up. HO formation occurred more in patients who underwent DLA, compared to PA (43(30%) vs. 21(18%), p = 0.024) after 6 years. However, the presence of severe HO (Brooker 3-4) was equal between the DLA and PA (7 vs. 5, p = 0.551). After 6 years the HHS and NRS for patient satisfaction were statistically significant higher after the PA (95.2 and 8.9, respectively) compared to the DLA (91.6 and 8.5, respectively) (p < 0.001 and p = 0.003, respectively). The NRS for load pain was statistically significant lower in the PA group (0.5) compared to the DLA group (1.2) (p = 0.004). The NRS for rest pain was equal: 0.3 in the PA group and 0.5 in the DLA group.
CONCLUSION
THA with the PA causes less HO formation than the DLA.
TRIAL REGISTRATION
Registrated as HipVit trial, NL 32832.100.10, R-10.17D/HIPVIT 1. Central Commission Human-Related research (CCMO) Registry.
目的
全髋关节置换术（THA）是一种成功的手术。然而，随着时间的推移，由于软组织损伤等原因，异位骨化（HO）可能形成。这可能导致疼痛和功能障碍。本研究比较了接受后路入路（PA）或直接外侧入路（DLA）THA 的患者之间 HO 的形成情况。我们的假设是，接受 PA 入路 THA 的患者形成的 HO 比接受 DLA 入路 THA 的患者少。
方法
这是一项前瞻性队列研究，共纳入 296 例连续接受 THA 的患者。其中 127 例接受 PA 入路 THA，169 例接受 DLA 入路 THA。这取决于外科医生的偏好和经验。超过 95%的患者主要诊断为原发性骨关节炎。使用数字评分量表（NRS）和髋关节 Harris 评分（HHS）对临床结果进行评分，使用 Brooker 分类对放射学 HO 进行评分。术后 1 年和 6 年进行随访。
结果
258 例（87%）患者完成了 6 年随访。与 PA 相比，接受 DLA 的患者 6 年后 HO 形成更多（43（30%）比 21（18%），p=0.024）。然而，DLA 和 PA 之间严重 HO（Brooker 3-4）的存在是相等的（7 比 5，p=0.551）。6 年后，PA 组患者满意度的 HHS 和 NRS 评分明显高于 DLA 组（分别为 95.2 和 8.9）（p<0.001 和 p=0.003）。PA 组的负荷疼痛 NRS 评分（0.5）明显低于 DLA 组（1.2）（p=0.004）。PA 组和 DLA 组的休息疼痛 NRS 评分相等：分别为 0.3 和 0.5。
结论
PA 入路 THA 引起的 HO 形成少于 DLA。
试验注册
以 HipVit 试验注册，NL 32832.100.10，R-10.17D/HIPVIT 1.中央委员会人类相关研究（CCMO）登记处。
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