Layson James T, Coon Matthew S, Sharma Rajan, Diedring Benjamin, Afsari Alan, Best Benjamin
Ascension Macomb Oakland Hospital.
Ascension St. John Hospital.
Spartan Med Res J. 2021 Aug 30;6(2):25096. doi: 10.51894/001c.25096. eCollection 2021.
The direct anterior approach (DAA) and anterolateral approach (ALA) may be used for hip hemiarthroplasty (HHA) as a treatment for femoral neck fractures. The DAA often utilizes intraoperative fluoroscopy to determine leg length and offset, while the ALA traditionally utilizes an intraoperative clinical exam to determine offset and leg length. This study will evaluate two techniques: the "grid fluoroscopy [GF] technique" and the "intraoperative exam [IE] technique," each performed by one of two separate surgeons, and compare each technique's accuracy to restore leg length and femoral offset in a patient population that underwent HHA.
Two investigators retrospectively reviewed charts of 208 randomly selected patients who had an HHA from either a DAA or ALA performed by two different surgeons for the treatment of femoral neck fractures. Postoperative AP pelvis radiographs were measured to determine offset and leg length compared with the non-operative extremity. Non-normal continuous variables were provided by median and interquartile range. Data were analyzed with the Mann-Whitney U test and Student's t-test.
After inclusion and exclusion criteria, data were reviewed on 173 hemiarthroplasties. The mean age was 80.3 years (± 11.2 years). Of the surgical patients, 65.9% were female, and 70.9% identified their ethnicity as white. The DAA was used in 93 patients and ALA in 80 patients. Analysis comparing the two techniques demonstrated no statistically significant differences in median leg length between GF technique (1.02 IQR -0.1, 2.0 mm) and IE technique (1.25 IQR -2.4, 1.3 mm,) (p=0.67). There was also no statistically significant difference in offset between GF technique (1.3 IQR 0.2, 2.1 mm) and IE technique (0.6 IQR -2.7 mm, 3.2 mm) (p=0.13). However, a difference was found in mean length of surgery that was statistically significant. We found that the mean length of surgery for the IE technique was 74.8 ± 24.7 minutes versus the GF technique, which was 95.1 ± 23.0 minutes, (p<0.0001).
There was no significant difference between leg length and offset with the use of intraoperative fluoroscopy with DAA compared to no intraoperative imaging with ALA. Our study suggests that DAA and ALA are equally effective approaches for re-establishing symmetric leg length and offset in HHA for femoral neck fractures. In this study, the ALA had a shorter surgical time compared to DAA, potentially due to the utilization of intraoperative fluoroscopy for this particular technique during the DAA.
直接前路（DAA）和前外侧入路（ALA）可用于髋关节半关节置换术（HHA）治疗股骨颈骨折。DAA通常利用术中透视来确定下肢长度和偏移，而ALA传统上利用术中临床检查来确定偏移和下肢长度。本研究将评估两种技术：“网格透视[GF]技术”和“术中检查[IE]技术”，分别由两位不同的外科医生之一进行操作，并比较这两种技术在接受HHA的患者群体中恢复下肢长度和股骨偏移的准确性。
两名研究者回顾性分析了208例随机选择的患者的病历，这些患者因股骨颈骨折接受了由两位不同外科医生进行的DAA或ALA的HHA手术。测量术后前后位骨盆X线片，以确定与未手术侧相比的偏移和下肢长度。非正态连续变量以中位数和四分位数间距表示。数据采用Mann-Whitney U检验和Student t检验进行分析。
经过纳入和排除标准后，对173例半关节置换术的数据进行了回顾。平均年龄为80.3岁（±11.2岁）。在手术患者中，65.9%为女性，70.9%确定其种族为白人。93例患者采用DAA，80例患者采用ALA。比较两种技术的分析表明，GF技术（1.02四分位数间距 -0.1，2.0毫米）和IE技术（1.25四分位数间距 -2.4，1.3毫米）之间的下肢长度中位数无统计学显著差异（p = 0.67）。GF技术（1.3四分位数间距 0.2，2.1毫米）和IE技术（0.6四分位数间距 -2.7毫米，3.2毫米）之间的偏移也无统计学显著差异（p = 0.13）。然而，发现手术平均时长存在统计学显著差异。我们发现IE技术的手术平均时长为74.8±24.7分钟，而GF技术为95.1±23.0分钟，（p<0.0001）。
与ALA不使用术中成像相比，DAA使用术中透视在下肢长度和偏移方面无显著差异。我们的研究表明，DAA和ALA在为股骨颈骨折进行HHA时重建对称下肢长度和偏移方面同样有效。在本研究中，ALA与DAA相比手术时间更短，这可能是由于DAA在该特定技术中使用了术中透视。
