直接前方入路在髋臼固定后转为全髋关节置换术是安全有效的。
The direct anterior approach for conversion to total hip arthroplasty after acetabular fixation is safe and effective.
机构信息
Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA.
Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA; Florida State College of Medicine, Tallahassee, FL, USA; University of Central Florida College of Medicine, Orlando, FL, USA.
出版信息
Injury. 2023 Oct;54(10):110975. doi: 10.1016/j.injury.2023.110975. Epub 2023 Aug 4.
INTRODUCTION
Total Hip Arthroplasty (THA) after prior acetabular fracture repair is known to be demanding as studies have shown inferior implant survival rates and higher infection rates for these procedures. The direct anterior (DA) approach might help mitigate some of these risks by utilizing a new surgical tissue plane. However, potential criticisms of the DA approach for these surgeries include the inability to access previous acetabular implants or heterotopic ossification (HO) if they were to inhibit implant placement. The goals of this study are to analyze the efficacy of the DA approach for conversion to hip arthroplasty surgery after previous acetabular fixation.
METHODS
After reviewing all records at our institution using current procedural terminology codes, we isolated patients with previous acetabular repair who underwent conversion to THA through the DA approach. Patient records were reviewed, and patients were contacted to obtain Harris Hip Scores.
RESULTS
23 patients (16 males and 7 females) were found with a mean follow-up time of 46 months (range 16-156 months). The mean age was 50 (range 28 - 83) and mean BMI was 28.5 (range 15.2 - 39.2). The average blood loss was 400 ml (range 200 - 900). The average operative time was 140 min (range 85-200 min). In 7 cases (32%) implants were encountered during acetabular reaming but the implants were either removed entirely or removed partially with a burr so that the acetabular cup could be positioned within acceptable parameters. In 2 cases pre-operative HO was encountered and was resected. The average Harris Hip Score at final follow-up was 92 (range 75 - 100). There were no deep infections and no neurovascular injuries encountered. 2 patients (9%) underwent revision surgery for aseptic femoral stem loosening. There was 1 anterior dislocation (4.5%) at 3 days post-operatively that was successfully treated with closed reduction and maintenance of hip precautions. Otherwise, the remaining 19 (86%) patients went on to uncomplicated recovery.
CONCLUSION
This is the largest known cohort analyzing the DA approach for conversion to hip arthroplasty after previous acetabular fixation. Overall, we demonstrate that the DAA is safe for conversion THA after acetabular fixation.
简介
已知全髋关节置换术（THA）在先前髋臼骨折修复后具有挑战性，因为研究表明这些手术的植入物存活率较低，感染率较高。直接前入路（DA）可能有助于通过利用新的手术组织平面来减轻这些风险。然而，对于这些手术，DA 入路的潜在批评包括如果先前的髋臼植入物或异位骨化（HO）妨碍植入物放置，则无法进入。本研究的目的是分析在先前髋臼固定后通过 DA 入路转换为髋关节置换术的疗效。
方法
在使用当前程序术语代码审查我们机构的所有记录后，我们分离出先前接受髋臼修复并通过 DA 入路转换为 THA 的患者。回顾患者记录，并联系患者获取 Harris 髋关节评分。
结果
发现 23 名患者（16 名男性和 7 名女性），平均随访时间为 46 个月（范围 16-156 个月）。平均年龄为 50 岁（范围 28-83 岁），平均 BMI 为 28.5（范围 15.2-39.2）。平均失血量为 400ml（范围 200-900ml）。平均手术时间为 140 分钟（范围 85-200 分钟）。在 7 例（32%）中，在髋臼扩孔时遇到植入物，但植入物要么完全取出，要么用磨头部分取出，以便髋臼杯能够处于可接受的参数范围内。在 2 例中，术前发现 HO 并进行了切除。最终随访时平均 Harris 髋关节评分为 92 分（范围 75-100）。无深部感染和神经血管损伤。2 例（9%）因无菌性股骨柄松动而行翻修手术。术后 3 天有 1 例前脱位（4.5%），经闭合复位和髋关节保护维持治疗成功。否则，其余 19 例（86%）患者恢复顺利。
结论
这是分析先前髋臼固定后通过 DA 入路转换为髋关节置换术的最大已知队列。总体而言，我们证明 DAA 用于髋臼固定后转换 THA 是安全的。
Zotero 插件