Objective To compare the clinical efficacy of the direct anterior approach(DAA) and the posterolateral approach(PLA)for total hip arthroplasty(THA) in the lateral decubitus position.Methods A retrospective study was performed on 102 patients who underwent primary unilateral THA that accepted in the Affiliated Hospital of Southwest Medical University from January 2016 to December 2017.There were 51 cases underwent DAA and 51 cases underwent posterolateral approach.There was no significant difference in gender,age etc.(P>0.05).The operation time,incision length,intraoperative blood loss,postoperative drainage,acetabulumposition,hospitalization time,postoperative complications and the Harris scores were recorded and compared.Results The patients had an average follow-up of 9.6(range,7~16)months.The operationtime in DAA and PLA was(66.8±11.3) minutes and(62.9±9.2)minutes,respectively.There was no significant difference in operation time between 2 groups(P<0.05).The incision length in DAA and PLA was(7.2±1.6) cm and(9.8±3.1) cm,respectively.The intraoperative blood loss was(58.3±11.2) mL and(86.8±12.3) mL,respectively.The postoperative drainage was(64.8±12.6) mL and(125.1±11.2)mL,respectively.The hospitalization time was(5.4±1.1) days and(7.8±1.8)days,respectively.There were statistically significant differences between the two groups in incision length,intraoperative blood loss,postoperative drainage and hospitalization time(P<0.05).The acetabular abduction angle was (38.4±6.2)° in the anterior group and was(37.9±5.7)° in the posterolateralgroup,showing no significant difference(P>0.05).The acetabularanteversion angle was (17.3±5.3)° in the anterior group and was (18.6±5.1)° in the posterolateral group,showing no significant difference(P>0.05).Harris scores of DAA was higher than that of PLA group after 1 month and 3 months of operation,the difference was statistically significant(P<0.05).Harris scores betweenthe two groups had no statistical significance in postoperative 6 months and latest follow-up(P>0.05).Further analysis,at 3 months after operation,the joint function score in DAA group was significantly higher than that in PLA group(P<0.05),while there was no significant difference in the pain score and range of motion score between 2 groups(P>0.05).VAS of DAA was less than that of PLA after 1 day,3 days,5 days and 7 days of operation,the difference between the two groups was statistically significant(P<0.05).There were 3 cases(5.8% ) of postoperative dislocation in PLA and no dislocation in DAA.There was 1 case(3.2% ) of lateral femoral cutaneous nerve injury in DAA.Conclusion Compared with the posterolateral approach,the direct anterior approach in the lateral decubitus position in total hip arthroplasty had the advantages of less bleeding,lesspain,faster postoperative recovery at early follow-up.
邓翔天,刘俊才,李忠 *,陈歌,尹一然,杨顺成,岳永川,赫明亮. 侧卧位直接前方入路与后外侧入路行全髋关节置换术的疗效分析[J]. 实用骨科杂志, 2018, 24(8): 692-700.
Deng Xiangtian,Liu Juncai,Li Zhong,et al. Comparison of Efficay of Direct Anterior Approach Versus Posterolateral Approach for Total Hip Arthroplasty in the Lateral Decubitus Position. sygkzz, 2018, 24(8): 692-700.
[1]Connolly KP,Kamath AF.Direct anterior total hip arthroplasty:Literature review of variations in surgical technique[J].World J Orthop,2016,7(1):38-43.
[2]SmithPetersen MN.A new supra-articular subperiosteal approach to the hip joint[J].Am J Orthop Surg( Phila Pa),1917(15):593
[3]Nogler M,Thaler M.Surgical access routes to the hip joint in the elderly [J].Orthopade,2017,46(1):18-24.
[4]Moerenhout KG,Cherix S,Rudiger HA.Total hip arthroplasty through anterior “minimal invasive” approach [J].Rev Med Suisse,2012,8(367):2429-2432.
[5]Melman WP,Mollen BP,Kollen BJ,et al.First experiences with the direct anterior approach in lateral decubitus position:learning curve and 1 year complication rate[J].Hip Int,2015,25(3):251-257.
[6]Pradhan R.Planar anteversion of the acetabular cup as determined from plain anteroposterior radiographs[J].J Bone Joint Surg(Br),1999,81(3):431-435.
[7]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.
[8]Rachbauer F,Kain MS,Leunig M.The history of the anterior approach to the hip[J].Orthop Clin North Am,2009,40(3):311-320.
[9]Goebel S,Steinert AF,Schillinger J,et al.Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach[J].Int Orthop,2012,36(3):491-498.
[10]Fransen B,Hoozemans M,Vos S.Direct anterior approach versus posterolateral approach in total hip arthroplasty:one surgeon,two approaches[J].Acta Orthop Belg,2016,82(2):240-248.
[11]Laffosse JM,Chiron P,Molinier F,et al.Prospective and comparative study of the anterolateral mini-invasive approach versus minimally invasive posterior approach for primary total hip replacement.Early results[J].Int Orthop,2007,31(5):597-603.
[12]Connolly KP,Kamath AF.Direct anterior total hip arthroplasty:Comparative outcomes and contemporary results[J].World J Orthop,2016,7(2):94-101.
[13]Alecci V,Valente M,Crucil M,et al.Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach:perioperative findings[J].J Orthop Traumatol,2011,12(3):123-129.
[14]Luo ZL,Chen M,Shang XF,et al.Direct anterior approach versus posterolateral approach for total hip arthroplasty in the lateral decubitus position [J].Zhonghua Yixue Zazhi,2016,96(35):2807-2812.
[15]Chen M,Luo Z,Ji X,et al.Direct anterior approach for total hip arthroplasty in the lateral decubitus position:our experiences and early results[J].J Arthroplasty,2017,32(1):131-138.
[16]赵海燕,夏亚一,康鹏德.直接前入路全髋关节置换与加速康复外科[J].中国矫形外科杂志,2017,25(15):1390-1393.
[17]Batailler C,Fary C,Batailler P,et al.Total hip arthroplasty using direct anterior approach and dual mobility cup:safe and efficient strategy against post-operative dislocation[J].Int Orthop,2017,41(3):499-506.
[18]Moskal JT,Capps SG,Scanelli JA.Anterior muscle sparing approach for total hip arthroplasty[J].World J Orthop,2013,4(1):12-18.
[19]Barnett SL,Peters DJ,Hamilton WG,et al.Is the anterior approach safe? early complication rate associated with 5090 consecutive primary total hip arthroplasty procedures performed using the anterior approach[J].J Arthroplasty,2016,31(10):2291-2294.
[20]Lee GC,Marconi D.Complications rollowing direct anterior hip procedures:costs to both patients and surgeons[J].J Arthroplasty,2015,30(9 Suppl):98-101.
[21]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.
[22]Meermans G,Konan S,Das R,et al.The direct anterior approach in total hip arthroplasty:a systematic review of the literature[J].Bone Joint J,2017,99(6):732-740.
[23]Macheras GA,Christofilopoulos P,Lepetsos P,et al.Nerve injuries in total hip arthroplasty with a mini invasive anterior approach[J].Hip Int,2016,26(4):338-343.
[24]Nogler MM,Thaler MR.The direct anterior approach for hip revision:accessing the entire femoral diaphysis without endangering the nerve supply[J].J Arthroplasty,2017,32(2):510-514.
[25]Bhargava T,Goytia RN,Jones LC,et al.Lateral femoral cutaneous nerve impairment after direct anterior approach for total hip arthroplasty[J].Orthopedics,2010,33(7):472.