Kamo Kenta
Department of Orthopaedics Surgery, Yamaguchi Red Cross Hospital, Yamaguchi, Japan.
Hip Pelvis. 2024 Sep 1;36(3):211-217. doi: 10.5371/hp.2024.36.3.211.
The concept of a superior approach (SA) involves the use of a tissue-sparing posterior approach (PA), with exposure of the piriformis muscle and gluteus medius/minimus muscles. The objective of this study was to clarify the features of hip hemiarthroplasty (HA) using a SA in regard to early recovery and mid-term outcomes, with a comparison of the outcomes of SA-HAs and HAs using a PA (PA-HAs).
A total of 120 HAs for treatment of primary femoral neck fracture with a healthy opposite hip joint were performed in our hospital from 2013 to 2018. Propensity score matching in regard to age, sex, body mass index, walking ability before injury, place of residence, time to surgery, and American Society of Anesthesiologists-Physical Status was performed for 79 patients with SA-HAs and 41 patients with PA-HAs. The final analysis included 34 patients who underwent SA-HAs and 34 patients who underwent PA-HAs.
The duration of surgery was 57.1 minutes and 72.1 minutes (=0.001) for SA-HAs and PA-HAs, respectively. The scores for walking ability at postoperative one week were 4.9±1.4 and 4.2±1.0 (=0.021) for SA-HAs and PA-HAs, respectively. The Barthel index (BI) at the start of rehabilitation was 26.2±18.7 and 17.4±16.3 (=0.042) for SA-HAs and PA-HAs, respectively. The 4-year complication-free survival rates were 74.2% and 56.3% for SA-HAs and PA-HAs, respectively (=0.310).
SA-HA can be performed without torsion of the muscles and ligaments around the hip joint. Early recovery of walking ability and BI was a significant feature of SA-HAs.
superior approach（SA）的概念涉及采用保留组织的后路入路（PA），显露梨状肌和臀中肌/臀小肌。本研究的目的是阐明采用SA进行髋关节半关节置换术（HA）在早期恢复和中期结果方面的特点，并比较SA-HA和采用PA的HA（PA-HA）的结果。
2013年至2018年，我院共对120例因原发性股骨颈骨折且对侧髋关节健康而进行的HA手术。对79例SA-HA患者和41例PA-HA患者进行了年龄、性别、体重指数、受伤前行走能力、居住地点、手术时间和美国麻醉医师协会身体状况方面的倾向评分匹配。最终分析纳入了34例行SA-HA的患者和34例行PA-HA的患者。
SA-HA和PA-HA的手术时间分别为57.1分钟和72.1分钟（P = 0.001）。术后1周时，SA-HA和PA-HA的行走能力评分分别为4.9±1.4和4.2±1.0（P = 0.021）。康复开始时，SA-HA和PA-HA的Barthel指数（BI）分别为26.2±18.7和17.4±16.3（P = 0.042）。SA-HA和PA-HA的4年无并发症生存率分别为74.2%和56.3%（P = 0.310）。
SA-HA可以在不扭转髋关节周围肌肉和韧带的情况下进行。SA-HA的一个显著特点是行走能力和BI的早期恢复。
