Dong Jiale, Kong Lingtong, Zhang Siming, Shang Xifu, Wang Jiaxing, Zhang Xianzuo, Zhu Chen
Department of Orthopedics, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, China.
Division of Life Sciences and Medicine, Department of Orthopedics, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China.
Front Surg. 2022 Feb 8;9:819530. doi: 10.3389/fsurg.2022.819530. eCollection 2022.
Total hip arthroplasty (THA) using the direct anterior approach (DAA) is becoming increasingly popular due to its potential benefits over the posterolateral approach (PLA). However, few studies have compared the efficacies of these two surgical approaches in hip fusion treatment. This study compared early clinical direct anterior and posterolateral THA outcomes in hip fusion treatment.
Here, 127 hips (65 DAA, 62 PLA) were retrospectively evaluated. Early postoperative functional outcomes of DAA and PLA groups were assessed using Harris score and Oxford Hip Score (OHS) and standard anteroposterior hip radiographs. Surgical characteristics, perioperative results, and complications within 6 months postoperatively were recorded.
Though baseline values were similar, Harris and OHS scores were better in the DAA group than in the PLA group at 1 and 3 months postoperatively. The average cup anteversion angle was significantly greater in the DAA group than in the PLA group (12.7° vs. 11.1°). More hips undergoing DAA were successfully orientated in both inclination and anteversion angles (46 vs. 32). Early postoperative hip function predictors were preoperative fused hip position, surgical approach, and range of motion. DAA was associated with reduced postoperative blood loss and shorter hospital stays. Furthermore, 14 vs. 8 complications occurred in the DAA vs. PLA group. Lateral femoral cutaneous nerve injuries were observed in eight hips (12.3%) of the DAA group.
For fused or ankylosed hips, THA using DAA in the lateral decubitus position may result in excellent prosthesis positioning and faster postoperative recovery throughout early follow-up vs. PLA.
采用直接前路（DAA）的全髋关节置换术（THA）因其相较于后外侧入路（PLA）具有潜在优势而越来越受欢迎。然而，很少有研究比较这两种手术入路在髋关节融合治疗中的疗效。本研究比较了髋关节融合治疗中直接前路与后外侧THA的早期临床疗效。
本研究对127例髋关节（65例采用DAA，62例采用PLA）进行了回顾性评估。采用Harris评分、牛津髋关节评分（OHS）以及标准的髋关节前后位X线片评估DAA组和PLA组术后早期的功能结局。记录手术特征、围手术期结果以及术后6个月内的并发症。
尽管基线值相似，但术后1个月和3个月时，DAA组的Harris评分和OHS评分均优于PLA组。DAA组的髋臼前倾角平均显著大于PLA组（12.7°对11.1°）。更多采用DAA的髋关节在倾斜角和前倾角方面均成功定位（46例对32例）。术后早期髋关节功能的预测因素为术前融合髋关节的位置、手术入路和活动范围。DAA与术后失血量减少和住院时间缩短相关。此外，DAA组发生14例并发症，PLA组发生8例并发症。DAA组有8例髋关节（12.3%）出现股外侧皮神经损伤。
对于融合或强直的髋关节，在侧卧位采用DAA进行THA与PLA相比，在早期随访期间可能会获得更好的假体定位和更快的术后恢复。
