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一种保留外展肌功能的改良经臀入路在全髋关节置换术中导致较低的术后脱位率:短期和长期结果的回顾性研究

A Modified Transgluteal Approach Sparing Abductor Function in Total Hip Arthroplasty Results in a Low Postoperative Dislocation Rate: A Retrospective Study of Short- and Long-Term Outcomes.

作者信息

Ward Michael H, Date Akshay, Yeoh Tien, Li Patrick

机构信息

Orthopaedics and Trauma, King's College London, London, GBR.

Orthopaedics, King's College Hospital, London, GBR.

出版信息

Cureus. 2024 Nov 16;16(11):e73804. doi: 10.7759/cureus.73804. eCollection 2024 Nov.

DOI:10.7759/cureus.73804
PMID:39552735
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11568664/
Abstract

Background A modified transgluteal approach in total hip arthroplasty (THA) can be utilized to preserve abductor muscle function and reduce dislocation rate. We present a study evaluating outcomes for a modified transgluteal approach using a validated patient-reported outcome measure (PROM) tool, the Oxford Hip Score (OHS). Methods This was a retrospective single-centre study over a four-year period. Short-term data was collected including intraoperative and postoperative complications, length of stay (LOS) in the hospital, and time from operation to mobilising independently. One year of data was collected, including plain radiograph findings and the incidence of Trendelenburg gait. Patients were contacted at a mean time of 2.7 years post-operatively so that OHS could be conducted. Results A total of 100 patients were identified within the inclusion criteria. The mean LOS for all patients was 2.8 days. The mean time from operation to mobilising independently without walking aids was 4.9 weeks. At the one-year follow-up, there was satisfactory radiographic assessment in 100% of patients. The mean OHS was 45.5 at 2.7 years, indicating satisfactory joint function in all patients. Conclusion This study supports the use of the modified transgluteal approach in THA, showing favourable outcomes in the time from operation to cessation in the use of walking aids, LOS and OHS. We report zero cases of Trendelenburg gait at the one-year follow-up and no dislocations at the three-year follow-up. Further studies are required to compare the outcomes of TGA to other approaches in THA.

摘要

背景

全髋关节置换术(THA)中改良经臀肌入路可用于保留外展肌功能并降低脱位率。我们开展了一项研究,使用经过验证的患者报告结局测量(PROM)工具——牛津髋关节评分(OHS)来评估改良经臀肌入路的效果。方法:这是一项为期四年的回顾性单中心研究。收集了短期数据,包括术中及术后并发症、住院时间(LOS)以及从手术到独立活动的时间。收集了一年的数据,包括X线平片检查结果和臀中肌步态的发生率。在术后平均2.7年时联系患者,以便进行OHS评估。结果:共纳入100例符合纳入标准的患者。所有患者的平均住院时间为2.8天。从手术到无需助行器独立活动的平均时间为4.9周。在一年随访时,100%的患者影像学评估结果满意。在2.7年时平均OHS为45.5,表明所有患者的关节功能良好。结论:本研究支持在THA中使用改良经臀肌入路,在从手术到停止使用助行器的时间、住院时间和OHS方面均显示出良好的效果。我们报告一年随访时无臀中肌步态病例,三年随访时无脱位病例。需要进一步研究来比较改良经臀肌入路与THA其他入路的效果。

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本文引用的文献

1
How Does Surgical Approach Affect Characteristics of Dislocation After Primary Total Hip Arthroplasty?初次全髋关节置换术后脱位的手术入路如何影响其特征?
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Comparing direct anterior approach versus posterior approach or lateral approach in total hip arthroplasty: a systematic review and meta-analysis.直接前侧入路与后侧或外侧入路在全髋关节置换术中的比较:系统评价和荟萃分析。
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Approaches for Total Hip Arthroplasty: A Systematic Review.
全髋关节置换术的方法:一项系统评价。
Cureus. 2023 Feb 10;15(2):e34829. doi: 10.7759/cureus.34829. eCollection 2023 Feb.
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The incidence of hip dislocation after posterior approach primary total hip arthroplasty: comparison of two different posterior repair techniques.后路初次全髋关节置换术后髋关节脱位的发生率:两种不同后路修复技术的比较。
Arch Orthop Trauma Surg. 2023 Jun;143(6):3605-3612. doi: 10.1007/s00402-022-04609-9. Epub 2022 Sep 15.
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Arthroplasty. 2019 Sep 3;1(1):5. doi: 10.1186/s42836-019-0008-2.
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Projections for primary hip and knee replacement surgery up to the year 2060: an analysis based on data from The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man.2060 年之前的英国全国髋关节和膝关节置换手术预测:基于英格兰、威尔士、北爱尔兰和马恩岛国家联合登记处数据的分析。
Ann R Coll Surg Engl. 2022 Jun;104(6):443-448. doi: 10.1308/rcsann.2021.0206. Epub 2021 Dec 23.
7
POSTERIOR VERSUS ANTERIOR APPROACH TO TOTAL HIP ARTHROPLASTY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.全髋关节置换术的后路与前路入路:随机对照试验的系统评价与荟萃分析
Acta Ortop Bras. 2021 Nov-Dec;29(6):297-303. doi: 10.1590/1413-785220212906244610.
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Comparisons between Direct Anterior Approach and Lateral Approach for Primary Total Hip Arthroplasty in Postoperative Orthopaedic Complications: A Systematic Review and Meta-Analysis.直接前入路与外侧入路初次全髋关节置换术后骨科并发症的比较:系统评价和荟萃分析。
Orthop Surg. 2021 Aug;13(6):1707-1720. doi: 10.1111/os.13101. Epub 2021 Aug 5.
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