前路全髋关节置换术的工作流程改变可提高生物力学重建的准确性，且不增加并发症风险。
A Workflow Change in Anterior Approach Total Hip Arthroplasty Leads to Improved Accuracy of Biomechanical Reconstruction Without Increased Risk of Complications.
作者信息
Kaszuba Stephanie V, Behrens Kyle M, Anderson Chad B, Gordon Alexander C
机构信息
Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Morton Grove, IL, USA.
出版信息
Arthroplast Today. 2021 Jul 15;10:99-104. doi: 10.1016/j.artd.2021.06.007. eCollection 2021 Aug.
BACKGROUND
During anterior approach total hip arthroplasty (THA), the femur may be an impediment for acetabular access, pushing reamers proximally and consequently altering the hip center. In an effort to address this, the senior author changed the surgical workflow from acetabulum first (AF) to femur first (FF). The objective of this study was to compare the precision of biomechanical hip reconstruction and clinical outcomes between the FF and AF techniques.
METHODS
This is a retrospective, case-control study of 267 anterior THAs (132 AF and 135 FF). A normal, contralateral hip was used to determine the native biomechanical parameters. Using a calibrated software program, radiographic measurements were performed to calculate the hip center position, femoral offset, global offset, and leg length of the operative and native hips using 2-week postoperative anteroposterior pelvis radiographs. Demographics, operative information, hemoglobin change, and complication data were obtained. Functional outcomes were assessed with the Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement survey at 1 year postoperatively.
RESULTS
The groups exhibited similar demographic characteristics. The FF group demonstrated significantly more accurate and more precise reconstruction of horizontal and vertical hip centers, femoral offset, and leg length. There was no significant difference in operative time, hemoglobin change, complication rate, or Hip Disability and Osteoarthritis Outcome Score, Joint Replacement scores between groups.
CONCLUSIONS
The FF technique allowed for more accurate and precise reconstruction of the hip center, leg length, and offset in THA than the AF workflow. Furthermore, the FF approach demonstrated no significant differences in complication rate or blood loss, nor in clinical outcomes.
LEVEL OF EVIDENCE
Therapeutic Study Level III.
背景
在前路全髋关节置换术（THA）中，股骨可能会妨碍髋臼的显露，将髋臼锉向上推，从而改变髋关节中心。为了解决这个问题，资深作者将手术流程从髋臼优先（AF）改为股骨优先（FF）。本研究的目的是比较FF和AF技术在生物力学髋关节重建精度和临床结果方面的差异。
方法
这是一项对267例前路THA（132例AF和135例FF）的回顾性病例对照研究。使用对侧正常髋关节来确定原始生物力学参数。使用校准软件程序，通过术后2周的骨盆前后位X线片对手术侧和健侧髋关节进行影像学测量，以计算髋关节中心位置、股骨偏心距、整体偏心距和腿长。收集人口统计学、手术信息、血红蛋白变化和并发症数据。术后1年使用髋关节功能障碍和骨关节炎置换结局评分量表评估功能结局。
结果
两组患者的人口统计学特征相似。FF组在水平和垂直髋关节中心、股骨偏心距和腿长的重建方面显示出明显更准确和精确。两组之间在手术时间、血红蛋白变化、并发症发生率或髋关节残疾和骨关节炎置换结局评分量表得分方面没有显著差异。
结论
与AF手术流程相比，FF技术在THA中能更准确和精确地重建髋关节中心、腿长和偏心距。此外，FF入路在并发症发生率、失血量或临床结果方面没有显著差异。
证据水平
治疗性研究III级。
Zotero 插件