Department of Orthopedic Surgery, Nihon University Hospital, 1-6, Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan.
Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610, Japan.
Medicina (Kaunas). 2022 May 26;58(6):713. doi: 10.3390/medicina58060713.
We performed anterolateral total hip arthroplasty (ALS THA) with the purpose of complete muscle-tendon preservation without muscle-tendon dissection. This study aimed to evaluate muscle damage in the periprosthetic hip joint muscles of patients undergoing ALS THA at 1-year post-operative hip magnetic resonance imaging (MRI). We evaluated changes in the muscle cross-sectional area (M-CSA) and fatty atrophy of the periprosthetic muscles. We also assessed the Harris hip score on pre-operative and 12-month post-operative MRI in 66 patients who underwent ALS THA. The grade of M-CSA atrophy was classified into no atrophy, slight atrophy, moderate atrophy, and severe atrophy. Fatty atrophy was classified as improved, no change, and worsened using the Goutallier classification. More than 90% of patients' M-CSA had no atrophy in the obturator internus (Oi), obturator externus (Oe), gluteus medius (Gmed), and gluteus minimus (Gmin), and some improvement was observed in terms of fatty atrophy. In contrast, M-CSA of the tensor fascia latae (TFL) muscle was clearly decreased, and there was no improvement in the TFL fatty atrophy. However, the presence or absence of TFL atrophy did not affect clinical outcome. We performed the complete muscle preserving procedure, ALS THA, with attention to preserving the Oi and Oe by direct visual confirmation and gentle treatment of the Gmed and Gmin with effective retraction. Post-operative M-CSA atrophy evaluation on MRI showed that the Oi, Oe, Gmed, and Gmin were satisfactorily preserved; however, the TFL was clearly atrophic. In the ALS approach, where entry is made between Gmed and TFL, atrophy of the TFL due to superior gluteal nerve injury must be tolerated to some extent.
我们进行了前外侧全髋关节置换术（ALS THA），目的是在不进行肌肉-肌腱解剖的情况下实现完全的肌肉-肌腱保留。本研究旨在评估接受 ALS THA 术后 1 年髋关节磁共振成像（MRI）的患者髋关节周围肌肉的肌肉损伤。我们评估了肌肉横截面积（M-CSA）的变化和髋关节周围肌肉的脂肪萎缩。我们还评估了 66 例接受 ALS THA 的患者术前和术后 12 个月髋关节 MRI 的 Harris 髋关节评分。M-CSA 萎缩程度分为无萎缩、轻度萎缩、中度萎缩和重度萎缩。脂肪萎缩采用 Goutallier 分级分为改善、无变化和恶化。超过 90%的患者的闭孔内肌（Oi）、闭孔外肌（Oe）、臀中肌（Gmed）和臀小肌（Gmin）的 M-CSA 无萎缩，脂肪萎缩有所改善。相比之下，阔筋膜张肌（TFL）的 M-CSA 明显减少，TFL 脂肪萎缩没有改善。然而，TFL 萎缩的存在与否并不影响临床结果。我们进行了完整的肌肉保留手术，即 ALS THA，通过直接视觉确认和轻柔处理 Gmed 和 Gmin 并有效牵拉来保留 Oi 和 Oe。术后 MRI 上的 M-CSA 萎缩评估显示，Oi、Oe、Gmed 和 Gmin 得到了满意的保留；然而，TFL 明显萎缩。在 ALS 入路中，由于臀上神经损伤，TFL 会出现一定程度的萎缩，必须在一定程度上耐受这种情况。
