Raufi Muhammad Y, Shrestha Sagaurav, Hamsho Ward, Rhodes Mahmoud
Trauma and Orthopedics, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, GBR.
Trauma and Orthopedics, Royal Cornwall Hospital National Health Service (NHS) Trust, Cornwall, GBR.
Cureus. 2025 Jul 31;17(7):e89115. doi: 10.7759/cureus.89115. eCollection 2025 Jul.
When elderly patients experience a displaced intracapsular hip fracture, hemiarthroplasty is still the go-to surgical treatment. More recently, a new approach called Sparing Piriformis and Internus, Repairing Externus (SPAIRE) has started gaining attention, in addition to the lateral and anterior approaches already being used. It's designed to lower the chances of dislocation and help patients recover better after surgery. This review looks at studies that have compared the SPAIRE technique with older, more established surgical methods, especially in terms of things like survival rates, where patients go after discharge, how much pain they feel after surgery, and any complications that come up, like hip dislocations and periprosthetic fractures. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies included randomized controlled trials (RCTs), non-RCTs, and observational studies that compared outcomes between patients undergoing hemiarthroplasty using either the SPAIRE technique or conventional lateral/anterior approaches. The total number of hips included in our study was 1385. Outcomes assessed included mortality, discharge destination, postoperative mobility, pain scores, and bone mineral density. Comparative evidence suggests that the SPAIRE approach may offer certain short-term advantages over conventional hemiarthroplasty techniques, particularly in terms of early postoperative mobility and pain management. However, these benefits do not appear to translate into significant long-term differences in functional recovery or patient-reported outcomes. Similarly, discharge destinations and bone health indicators show no consistent variation between SPAIRE and other commonly employed surgical approaches. Overall, the available literature indicates that while SPAIRE may provide early postoperative benefits, its long-term outcomes are broadly comparable to alternative methods. To our knowledge, this is the first systematic review comparing the SPAIRE approach with established surgical techniques in hip hemiarthroplasty. While some outcomes suggest potential advantages with SPAIRE, the current evidence base is limited. Further high-quality, large-scale studies are required to determine its definitive clinical benefit over traditional approaches.
当老年患者发生囊内移位型髋部骨折时，半髋关节置换术仍是首选的外科治疗方法。最近，一种名为保留梨状肌和闭孔内肌、修复闭孔外肌（SPAIRE）的新方法开始受到关注，此外还有已经在使用的外侧入路和前侧入路。它旨在降低脱位几率，并帮助患者术后更好地恢复。本综述研究了将SPAIRE技术与更成熟的传统手术方法进行比较的研究，特别是在生存率、出院后去向、术后疼痛程度以及出现的任何并发症（如髋关节脱位和假体周围骨折）等方面。本综述是按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行的。符合条件的研究包括随机对照试验（RCT）、非RCT和观察性研究，这些研究比较了采用SPAIRE技术或传统外侧/前侧入路进行半髋关节置换术的患者之间的结局。我们研究纳入的髋关节总数为1385个。评估的结局包括死亡率、出院去向、术后活动能力、疼痛评分和骨密度。比较证据表明，SPAIRE入路可能比传统半髋关节置换术具有某些短期优势，特别是在术后早期活动能力和疼痛管理方面。然而，这些益处似乎并未转化为功能恢复或患者报告结局方面的显著长期差异。同样，出院去向和骨骼健康指标在SPAIRE与其他常用手术入路之间没有一致的差异。总体而言，现有文献表明，虽然SPAIRE可能在术后早期带来益处，但其长期结局与其他方法大致相当。据我们所知，这是第一项比较SPAIRE入路与髋部半髋关节置换术中既定手术技术的系统评价。虽然一些结局表明SPAIRE有潜在优势，但目前的证据基础有限。需要进一步开展高质量、大规模的研究来确定其相对于传统方法的确切临床益处。
