Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan.
Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan.
Surgeon. 2022 Oct;20(5):e254-e261. doi: 10.1016/j.surge.2021.09.001. Epub 2021 Nov 15.
Total hip arthroplasty (THA) using a minimally invasive (MI) approach is a commonly performed procedure, and several approaches are now being used clinically. The MI anterolateral (MIAL) approach is one of the MI approaches used in clinical practice. Whether the MIAL approach is superior to non-MI approaches remains controversial. To resolve this controversy, we performed a systematic review and a meta-analysis of results of THA procedures that used the MIAL approach. We assessed whether the MIAL approach was superior to the lateral transmuscular (LT) approach in terms of operative time, operative blood loss, radiological parameters, and clinical outcomes.
We performed a methodical search for all literature published on PubMed, Web of Science, and the Cochrane Library, and pooled data using the RevMan software. A p value < 0.05 was considered statistically significant. We calculated the mean differences (MD) for continuous data with 95% confidence intervals (CI) for each outcome.
This meta-analysis included 6 studies. Pooled results indicated no statistically significant differences between the groups in terms of operative time (MD = 5.13, 95% CI -2.49 to 12.75, p = 0.19), cup abduction angle (MD = 1.64, 95% CI -1.32 to 4.60, p = 0.28), and cup anteversion angle (MD = 0.75, 95% CI -1.09 to 2.59, p = 0.43). Operative blood loss was significantly greater in those who underwent THA via the MIAL approach than those who underwent THA via the LT approach (MD = 68.01, 95% CI 14.69 to 121.33, p = 0.01). The postoperative Harris hip score (HHS) assessed at the time of final follow-up was significantly higher in those who underwent THA via the MIAL approach than those who underwent THA via the LT approach (MD = 1.41, 95% CI 0.50 to 2.33, p = 0.002).
We conclude that the MIAL approach is superior to the LT approach in terms of clinical outcomes.
Level Ⅱ.
全髋关节置换术（THA）采用微创（MI）入路是一种常见的手术方法，目前临床上有几种入路方法。MI 前外侧（MIAL）入路是临床应用的 MI 入路之一。MIAL 入路是否优于非 MI 入路仍存在争议。为了解决这一争议，我们对采用 MIAL 入路的 THA 手术结果进行了系统评价和荟萃分析。我们评估了 MIAL 入路在手术时间、手术失血量、影像学参数和临床结果方面是否优于外侧经肌入路（LT）。
我们在 PubMed、Web of Science 和 Cochrane 图书馆上对所有已发表的文献进行了系统搜索，并使用 RevMan 软件对数据进行了汇总。p 值<0.05 被认为具有统计学意义。我们计算了每个结果的连续数据的均数差值（MD）及其 95%置信区间（CI）。
这项荟萃分析纳入了 6 项研究。汇总结果表明，两组在手术时间（MD=5.13，95%CI-2.49 至 12.75，p=0.19）、杯外展角（MD=1.64，95%CI-1.32 至 4.60，p=0.28）和杯前倾角（MD=0.75，95%CI-1.09 至 2.59，p=0.43）方面无统计学差异。MIAL 入路组的手术失血量明显多于 LT 入路组（MD=68.01，95%CI 14.69 至 121.33，p=0.01）。末次随访时，采用 MIAL 入路的患者的术后 Harris 髋关节评分（HHS）明显高于采用 LT 入路的患者（MD=1.41，95%CI 0.50 至 2.33，p=0.002）。
我们的结论是，MIAL 入路在临床结果方面优于 LT 入路。
2 级。
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