Unwin A J, Thomas M
Chelsea and Westminster Hospital, London.
Ann R Coll Surg Engl. 1994 Sep;76(5):327-9.
We compared the 3-month dislocation rate for hip hemiarthroplasties inserted via the posterior and direct lateral routes. In all, 2906 primary hemiarthroplasties, performed between 1986 and 1992 in four hospitals on a training hospital rotation, were analysed. The posterior approach was used in 1656 (57%) and the lateral in 1250 (43%). The groups were otherwise comparable. The overall dislocation rate for the posterior approach was 9.0% (149/1656), whereas that for the direct lateral approach was 3.3% (41/2150). The difference is statistically highly significant. In addition, we analysed the dislocation rate for each approach in the three broad groups of surgical trainee. For senior registrars, there was no statistical difference in the dislocation rate. However, for registrars and senior house officers, there were statistically highly significant differences in the dislocation rate for posterior and direct lateral approaches (8.4% vs 3.3% and 14.2% vs 3.6%, respectively). We conclude that, because of the high mortality associated with dislocation of a hemiarthroplasty, the posterior approach for this operation should now be abandoned, especially by surgical trainees early in their careers.
我们比较了经后路和直接外侧入路进行髋关节半关节置换术后3个月的脱位率。对1986年至1992年期间在四家医院进行的2906例初级半关节置换术进行了分析，这些手术是在教学医院轮转期间完成的。其中1656例（57%）采用后路入路，1250例（43%）采用外侧入路。其他方面两组具有可比性。后路入路的总体脱位率为9.0%（149/1656），而直接外侧入路的脱位率为3.3%（41/1250）。差异具有高度统计学意义。此外，我们分析了三组外科实习生中每种入路的脱位率。对于高级住院医师，脱位率没有统计学差异。然而，对于住院医师和高级住院医生，后路和直接外侧入路的脱位率存在高度统计学差异（分别为8.4%对3.3%和14.2%对3.6%）。我们得出结论，由于半关节置换术后脱位相关的高死亡率，现在应该放弃该手术的后路入路，尤其是对于职业生涯早期的外科实习生。
