Xu Zhonghua, Zhang Jun, Li Jie, Zhang Yuan
Joint Disease & Sport Medicine Center, Department of Orthopedic Surgery, Xinqiao Hospital, Army Medical University, 183 Xinqiao street, Shapingba District, Chongqing, 400038, China.
Arthroplasty. 2022 Jul 8;4(1):29. doi: 10.1186/s42836-022-00130-x.
Mounting attention has been oriented to the direct anterior approach (DAA) in total hip arthroplasty (THA) because of alleged advantages in terms of tissue-sparing and minimal invasiveness, as well as fast recovery after surgery in the past decades. Doubt has also been raised by critics regarding learning curve, indications, technical feasibility, intraoperative risks and complications, and unconfirmed long-term consequences of the approach. The controversies were elaborately reviewed and discussed in a recent publication in Arthroplasty by Realyvasquez et al. from the perspective of American surgeons. This inclusive review covered the current status, technical issues, outcome evaluation, and developmental concerns of DAA in modern THA. As one of the pioneers of DAA in hip surgery communities in China, Prof. Y. Z., the corresponding author of the paper, has his own understanding and manipulation of DAA on the basis of thousands of DAA procedures he has performed. The purpose of this article was to respond to the pivotal issues discussed in the article by Realyvasquez et al., and to present our own view of points about the indications/contraindications and advantages as different from existing ideas. In particular, we proposed a Xinqiao Predictive Algorithm to quantitatively assess the indications for and feasibility of DAA for the first time. The algorithm was constructed on multiple factors derived from Chinese patients. Our study concluded that the potential advantages of DAA could be achieved by personalizing the pelvic functional position and placing the component into the real safe zone, by means of adapting to the spaciotemporal change of the hip-spine coordination.
在过去几十年中，由于全髋关节置换术（THA）的直接前路（DAA）在组织保留和微创方面具有所谓的优势，以及术后恢复快，因此受到了越来越多的关注。批评者也对该方法的学习曲线、适应症、技术可行性、术中风险和并发症以及未经证实的长期后果提出了质疑。Realyvasquez等人最近在《关节置换术》上发表的一篇文章从美国外科医生的角度对这些争议进行了详尽的回顾和讨论。这篇全面的综述涵盖了现代THA中DAA的现状、技术问题、结果评估和发展问题。作为中国髋关节手术领域DAA的先驱之一，该论文的通讯作者Y.Z.教授在他所进行的数千例DAA手术的基础上，对DAA有自己的理解和操作方法。本文的目的是回应Realyvasquez等人文章中讨论的关键问题，并提出我们自己关于适应症/禁忌症和优势的观点，与现有观点不同。特别是，我们首次提出了一种新桥预测算法，用于定量评估DAA的适应症和可行性。该算法是基于从中国患者中得出的多个因素构建的。我们的研究得出结论，DAA的潜在优势可以通过个性化骨盆功能位置并将假体组件放置到真正的安全区域来实现，这需要适应髋部-脊柱协调的时空变化。
