初次全髋关节置换术中后外侧入路与直接前方入路对解剖柄位置的影响

Abstract
Figure/Table
References (0)
Related Citation (15)

Download: PDF (1221 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To explore the influence of the posterolateral approach and the direct anterior approach on the position of the prosthesis stem and the analysis of the factors affecting the anteversion angle of the femur in the initial total hip arthroplasty.Methods A total of 108 cases of 114 hip joints were included in our hospital from June 2015 to June 2020 in which the same doctor used an anatomical stem for the first total hip replacement.The flexion range of the affected hip was less than 60°，the lower extremity needs to be extended more than 2 cm，the BMI was more than 30 kg／m² and the patient requires the posterolateral approach to use the posterolateral approach approach，the rest of the patients use the posterolateral approach approach，posterolateral approach group has 44 cases of hips，male There were 24 hips and 20 female hips，with an average age of (60.1±12.1)years.There were 70 hips in the posterolateral approach group，of which 38 were male hips and 32 were female hips，with an average age of (59.8±11.4)years.The patient lies in the supine position，CT scans the affected side (anterior superior iliac spine to tibial tubercle)，reconstructs the three-dimensional figure of the femur，and measures the position of the femoral prosthetic stem in the sagittal，coronal and horizontal planes，anteversion angle，and osteotomy from the lesser tuberosity Distance and the anteroposterior distance of the femoral head.Results Before the operation，the anteversion angle of the femur was (23.2±10.4)° in the posterolateral approach group and (27.7±10.9)° in the posterolateral approach group.The difference between the two groups was statistically significant (P＝0.003).The postoperative femoral anteversion angles of the two groups were (28.5±11.5)° and (30.7±9.2)°，respectively，and the difference was not statistically significant (P＝0.141).After the comparison of the changes in the anteversion angle between the two groups，the difference was statistically significant (P＝0.043)；the difference between the sagittal and sagittal angles of the prosthesis was statistically significant (P＝0.008，P＝0.003).The preoperative anteversion angle was related to the postoperative anteversion angle，and the difference was statistically significant (P＝0.001)；the difference between posterolateral approach approach flexion implantation and posterolateral approach approach implantation was statistically significant (P＝0.043)；femoral head There was no statistically significant difference in the changes of the front-to-back distance between the two approaches (P＝0.882).Conclusion The preoperative femoral anteversion angle is a factor that affects the postoperative anteversion angle.The surgical approach does not affect the postoperative anteversion angle and the change of the femoral head's anteroposterior distance.The surgical approach affects the position of the prosthesis stem in the sagittal plane.

Key words： total hip arthroplasty posterolateral approach direct anterior approach anatomic stems femoral anteversion

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors

Cite this article:

URL:

http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2021/V27/I2/97

［1］Learmonth ID，Young C，Rorabeck C.The operation of the century：total hip replacement［J］.Lancet，2007，370(9597)：1508-1519.
［2］Johnsen SP，Sorensen HT，Lucht U，et al.Patient-related predictors of implant failure after primary total hip replacement in the initial，short-and long-terms：a nationwide danish follow-up study including 36 984 patients［J］.J Bone Joint Surg(Br)，2006，88(10)：1303-1308.
［3］Crawford RW，Murray DW.Total hip replacement：indications for surgery and risk factors for failure［J］.Ann Rheum Dis，1997，56(8)：455-457.
［4］Nakashima Y，Hirata M，Akiyama M，et al.Combined anteversion technique reduced the dislocation in cementless total hip arthroplasty［J］.Int Orthop，2014，38(1)：27-32.
［5］Fukunishi S，Nishio S，Fujihara Y，et al.Accuracy of combined anteversion in image-free navigated total hip arthroplasty：stem-first or cup-first technique?［J］.Int Orthop，2016，40(1)：9-13.
［6］Lindgren JV，Wretenberg P，Kärrholm J，et al.Patient-reported outcome is influenced by surgical approach in total hip replacement：a study of the swedish hip arthroplasty register including 42 233 patients［J］.Bone Joint J，2014，96(5)：590-596.
［7］Free MD，Owen DH，Agius PA，et al.Direct anterior approach total hip arthroplasty：an adjunct to an enhanced recovery pathway：outcomes and learning curve effects in surgeons transitioning from other surgical approaches［J］.J Arthroplasty，2018，33(11)：3490-3495.
［8］Seagrave KG，Troelsen A，Malchau H，et al.Acetabular cup position and risk of dislocation in primary total hip arthroplasty：a systematic review of the literature［J］.Acta Orthop，2017，88(1)：10-17.
［9］Belzunce M A，Henckel J，Di Laura A，et al.Uncemented femoral stem orientation and position in total hip arthroplasty：A CT study［J］.J Orthop Res，2020，38(7)：1486-1489.
［10］Hayashi S，Hashimoto S，Matsumoto T，et al.Stem anteversion mismatch to the anatomical anteversion causes loss of periprosthetic bone density after THA［J］.J Orthopa Surg(Hong Kong)，2017，25(3)：2309499017739478.
［11］Sariali E，Mauprivez R，Khiami F，et al.Accuracy of the preoperative planning for cementless total hip arthroplasty.A randomised comparison between three-dimensional computerised planning and conventional templating［J］.Orthop Traumatol Surg Res，2012，98(2)：151-158.
［12］Kobayashi，H，Homma Y，Baba T，et al.Surgeons changing the approach for total hip arthroplasty from posterior to direct anterior with fluoroscopy should consider potential excessive cup anteversion and flexion implantation of the stem in their early experience［J］.Int Orthop，2016，40(9)：1813-1819.
［13］Rojas J，Bautista M，Bonilla G，et al.A retrospective study on the relationship between altered native acetabular angle and vertical implant malpositioning［J］.Int Orthop，2018，42(4)：769-775.
［14］Widmer KH，Zurfluh B.Compliant positioning of total hip components for optimal range of motion［J］.J Orthop Res，2004，22(4)：815-821.
［15］Amuwa C，Dorr LD.The combined anteversion technique for acetabular component anteversion［J］.J Arthroplasty，2008，23(7)：1068-1070.
［16］Dorr LD，Malik A，Dastane M，et al.Combined anteversion technique for total hip arthroplasty［J］.Clin Orthop Relat Res，2009(467)：119-127.
［17］Tsai TY，Dimitriou D，Li G，et al.Does total hip arthroplasty restore native hip anatomy? Three-dimensional reconstruction analysis［J］.Int Orthop，2014，38(8)：1577-1583.
［18］Viceconti M，Brusi G，Pancanti A，et al.Primary stability of an anatomical cementless hip stem：a statistical analysis［J］.J Biomechanics，2006，39(7)：1169-1179.
［19］Müller M，Crucius D，Perka C，et al.The association between the sagittal femoral stem alignment and the resulting femoral head centre in total hip arthroplasty［J］.Int Orthop，2011，35(7)：981-987.
［20］Emerson RH.Increased anteversion of press-fit femoral stems compared with anatomic femur［J］.Clin Orthop Relat Res，2012(470)：477-481.
［21］Renkawitz T，Haimerl M，Dohmen L，et al.The association between Femoral Tilt and impingement-free range-of-motion in total hip arthroplasty［J］.BMC Musculoskelet Disord，2012，13(1)：65.