不同手术入路对髋臼假体安放位置的影响及原因分析

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1792 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的了解直接前侧入路(direct anterior approach，DAA)全髋关节置换术与传统后外侧入路(posterior lateral approach，PLA)全髋关节置换术(total hip arthroplasty，THA)髋臼侧假体位置准确性差异及可能原因。方法回顾性分析我院2017年1月1日至2017年12月31日行人工全髋关节置换手术患者共118例，其中DAA共56例，男18例，女38例；年龄46~85岁，平均年龄(59.4±12.8)岁。PLA共62例，男35例，女27例；年龄52~86岁，平均年龄(63.2±10.6)岁。所有患者均无明显术前畸形。髋臼侧假体均采用生物型压配式假体。通过双髋正位X线片测量髋臼侧假体外展角，CT平扫测量髋臼侧假体前倾角。结果所有患者均未出现脱位、感染等并发症，DAA组患者平均手术时间(80.5±21.1)min，PLA组患者平均手术时间(61.2±11.2)min。DAA组髋臼假体外展角度为(38.2±7.6)°，前倾角度为(14.9±4.5)°；PLA组髋臼假体外展角度为(36.7±11.9)°，前倾角度为(18.7±7.3)°。两组患者外展角差异无统计学意义(P＝0.57)，但PLA组患者假体前倾角高于DAA组，差异有统计学意义(P＝0.019)。DAA组的前倾角在“假体位置安全区”的比例为82%(46/56)，PLA组为62.9%(39/62)。DAA组的外展角在“假体位置安全区”的比例为91%(51/56)，PLA组为72.5%(45/62)。结论 DAA组髋臼假体前倾角安放准确性较PLA入路更稳定，且在“假体位置安全区”的比例更高，但两组外展角安放准确性方面差异无统计学意义。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：手术入路, 临床疗效, 人工关节置换, 微创, 并发症

Abstract：Objective To study and analyze the difference about acetabular prosthesis positional accuracy between direct anterior approach(DAA) and conventional posterior lateral approach(PLA) in the total hip arthroplasty.Methods This is a retrospective study about 118 patients with total hip arthroplasty from January 1，2017 to December 31，2017.The DAA group had 56 patients，including 18 male and 38 female with an average age of (59.4±12.8)(range 46~85).The PLA group had 62 patients，including 35 male and 27 female with an average age of (63.2±10.6)(range：52~86).All patients were not obvious preoperative hip deformity.The acetabular component was a cementless prosthesis(pinnacle，R3，LCU link).The acetabular abduction angle and acetabular anteversion angle was measured by a hip X-ray.Results All patients had no serious complications such as dislocation and infection.The average operation time was (80.5±21.1)minutes in the DAA group and (61.2±11.2)minutes in the PLA group.In the DAA group，the acetabular abduction was (38.2±7.6)°，the acetabular anteversion angle was (14.9±4.5)°.In the PLA group，the acetabular abduction angle was (36.7±11.9)°，and the acetabular anteversion angle was (18.7±7.3)°.There was no significant statistic difference in abduction angle between the two groups(P＝0.57)，but the acetabular anteversion angle was higher in the PLA group than in the DAA group.There was a statistically significant difference between the two groups in the acetabular anteversion angle(P＝0.019).The anteversion angle of the DAA group was 82%(46/56) in the“Safe Zone” and 62.9%(39/62) in the PLA group.The abduction angle of the DAA group was 91%(51/56) in the“Safe Zone”and 72.5%(45/62) in the PLA group.Conclusion The accuracy of the acetabular anteversion angle in the DAA group is more stable than the PLA group.The DAA group's proportion in the “Safe Zone” is higher than the PLA group，but there is no statisical difference in the acetabular abduction angle between the two groups.

Key words： approach clinical effect arthroplasty minimal invasive complication

PACS:

null

通讯作者: 王波

作者简介: 忻慰(1988－ )，男，医师，海军军医大学附属长征医院关节外科，200003。

引用本文:

忻慰，王波 *，陈宜，符培亮，彭锦辉，付奇伟，曹嘉，邵加华，刘宁，钱齐荣. 不同手术入路对髋臼假体安放位置的影响及原因分析[J]. 实用骨科杂志, 2019, 25(8): 690-694.
Xin Wei，Wang Bo *，Chen Yi，et al. Effect of Different Total Hip Arthroplasty Surgical Approaches on Acetabular Prothesis Position and Reason Analysis. sygkzz, 2019, 25(8): 690-694.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2019/V25/I8/690

［1］Barrett WP，Turner SE，Leopold JP.Prospective randomized study of direct anterior vs postero-lateral approach for total Hip arthroplasty［J］.J Arthroplasty，2013，28(9)：1634-1638.
［2］Mayr E，Nogler M，Benedetti MG，et al.A prospective randomized assessment of earlier functional recovery in THA patients treated by minimally invasive direct anterior approach：a gait analysis study［J］.Clin Biomech(Bristol，Avon)，2009，24(10)：812-818.
［3］Nakata K，Nishikawa M，Yamamoto K，et al.A clinical comparative study of the direct anterior with mini-posterior approach：Two consecutive series［J］.J Arthroplasty，2009，24(5)：698-704.
［4］孙凤歧，李盛华.国内微创全髋关节置换术的研究现状［J］.实用骨科杂志，2012，7(18)：3.
［5］Jewett BA，Collis DK.High complication rate with anterior total hip arthroplasties on a fracture table［J］.Clin Orthop Relat Res，2011，469(2)：503-507.
［6］Jolles BM，Zangger P，Leyvraz PF.Factors predisposing to dislocation after primary total hip arthroplasty：a multivariate analysis［J］.J Arthroplasty，2002，17(3)：282-288.
［7］Sculco PK，Austin MS，Lavernia CJ，et al.Preventing leg length discrepancy and instability after total hip arthroplasty［J］.Instr Course Lect，2016(65)：225-241.
［8］Danoff JR，Bobman JT，Cunn G，et al.Redefining the acetabular component safe zone for posterior approach total hip arthroplasty［J］.J Arthroplasty，2016，31(2)：506-511.
［9］Tripuraneni KR，Munson NR，Archibeck MJ，et al.Acetabular abduction and dislocations in direct anterior vs posterior total hip arthroplasty：A retrospective，matched cohort study［J］.J Arthroplasty，2016，31(10)：2299-2302.
［10］Clohisy JC，Carlisle JC，Beaulé PE，et al.A systematic approach to the plain radiographic evaluation of the young adult hip［J］.J Bone Joint Surg(Am)，2008，90(4)：47-66.
［11］Lewinnek GE，Lewis JL，Tarr R，et al.Dislocations after total hip-replacement arthroplasties［J］，J Bone Joint Surg(Am)，1978，60(2)：217-220.
［12］Qin Y，Li X，Chen S，et al.Correcting pelvic obliquity in the lateral position to improve acetabular component orientation during total hip arthroplasty［J］.Technol Health Care，2017(21)：1-9.
［13］Iwakiri K，Kobayashi A，Ohta Y，et al.Efficacy of a pelvic lateral positioner with a mechanical cup navigator based on the anatomical pelvic plane in total hip arthroplasty［J］.J Arthroplasty，2017，32(12)：3659-3664.
［14］James CR，Peterson BE，Crim JR，et al.The use of fluoroscopy during direct anterior hip arthroplasty：powerful or misleading?［J］.J Arthroplasty，2018，33(6)：1775-1779.
［15］Tezuka T，Heckmann ND，Bodner RJ，et al.Functional safe zone is superior to the lewinnek safe zone for total hip arthroplasty：why the lewinnek safe zone is not always predictive of stability［J］.J Arthroplasty，2019，34(1)：3-8.
［16］Pierrepont J，Hawdon G，Miles BP，et al.Variation in functional pelvic tilt in patients undergoing total hip arthroplasty［J］.Bone Joint J，2017，99(2)：184-191.
［17］Esposito CI，Carroll KM， Sculco PK， et al.Total hip arthroplasty patients with fixed spinopelvic alignment are at higher risk of hip dislocation［J］.J Arthroplasty，2018，33(5)：1449-1454.