身体质量指数对直接前路假体植入和术后并发症的影响

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

Download: PDF (1275 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To investigate whether the body mass index (BMI) will affect the implantation and complications of the direct anterior approach (DAA).Methods The data of 145 patients who underwent DAA unilateral total hip arthroplasty in our department from June 2019 to January 2021 was retrospectively analyzed.All patients were divided into 4 groups according to the Chinese BMI classification.Low body weight：BMI<18 kg／m²；normal body reconstitution：18.5 kg／m²≤BMI＜24 kg／m²；super recombination：24 kg／m²≤BMI＜28 kg／m²；obesity group：BMI≥28 kg／m².There were 17 cases of low body recombination，11 males and 6 females.Theage ranged from 51 to 65 years，with an average of 54 years old.There were 48 cases of normal body reorganization，25 males and 23 females.The age ranged from 49 to 64 years，with an average of 56 years old.There were 56 cases of overweight，including 36 males and 20 females.They were 48~62 years old，with an average of 57 years old.There were 24 cases in the obesity group，including 14 males and 10 females.The age ranged from 52 to 60 years，with an average of 53 years.The imaging evaluation indexes of prosthesis implantation，operation status and early complications at 3 months after operation were compared among the groups.Results In the case of prosthesis implantation，the average anteversion angle of all patients was 20.10°.With the increase of BMI，the anteversion angle of the acetabular prosthesis gradually increased among the groups，and the differences between the groups were significant(P＜0.05)，but 97.24％ of the acetabular anteversion angle was within the safe zone.Comparison between the acetabular prosthesis's external abduction angle，femoral prosthesis's internal valgus angle，eccentricity change，and the length of both lower limbs showed no statistically significant difference (P＞0.05).Patients in the obesity group had longer operation time and incision length，and the difference between the groups was statistically significant (P＜0.05).A total of 5 patients in all cohorts had intraoperative fractures.3 patients had delayed incision healing.There were no dislocations and deep infections.Surgical blood loss and visual analogue scale(VAS) on the third day after surgery showed no difference(P＞0.05).There was no significant difference in intraoperative and early postoperative complications (P＞0.05).Conclusion When obese patients undergo DAA total hip arthroplasty，the difficulty of the operation increases，and the anteversion angle of the acetabular prosthesis tends to be larger，but the safety of the prosthesis implantation will not be reduced.DAA is a safe and reliable operation methodfor non-morbidly obese patients.

Key words： body mass index direct anterior approach total hip replacement prosthesis implantation complications

	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/I12/1070

［1］Rachbauer F，Kain MSH，Leunig M.The history of the anterior approach to the hip［J］.Orthop Clin North Am，2009，40(3)：311-320.
［2］Patel NN，Shah JA，Erens GA.Current trends in clinical practice for the direct anterior approach total hip arthroplasty.［J］.J Arthroplasty，2019，34(9)：1987-1993.
［3］张其亮，任国清，周健，等.直接前入路与后外侧入路全髋关节置换术的比较［J］.中国矫形外科杂志，2020，28(17)：1548-1552.
［4］Singh V，Zak S，Schwarzkopf R，et al.Forgotten joint score in THA：comparing the direct anterior approach to posterior approach［J］.J Arthroplasty，2020，35(9)：2513-2517.
［5］Sang Weilin，Zhu Libo，Ma Jinzhong，et al.The influence of body mass index and hip anatomy on direct anterior approach total hip replacement［J］.Med Princ Pract，2016，25(6)：555-560.
［6］Elson LC，Barr CJ，Chandran SE，et al.Are morbidly obese patients undergoing total hip arthroplasty at an increased risk for component malpositioning?［J］.J Arthroplasty，2013，28(8)：41-44.
［7］Haynes J，Nam D，Barrack RL.Obesity in total hip arthroplasty：does it make a difference?［J］.Bone Joint J，2017，99B(1 Supple A)：31-36.
［8］Antoniadis A，Dimitriou D，Flury A，et al.Is direct anterior approach a credible option for severely obese patients undergoing total hip arthroplasty? amatched-control，retrospective，clinical Study［J］.J Arthroplasty，2018，33(8)：2535-2540.
［9］Barrack RL，Krempec JA，Clohisy J，et al.Accuracy of acetabular component position in hip arthroplasty［J］.J Bone Joint Surg (Am)，2013，95(19)：1760-1768.
［10］卞荣鹏，陈康，朱浩.全髋关节置换术后假体周围感染的独立危险因素分析［J］.中国骨与关节损伤杂志，2020，35(4)：368-370.
［11］中国肥胖问题工作组数据汇总分析协作组.我国成人体重指数和腰围对相关疾病危险因素异常的预测价值：适宜体重指数和腰围切点的研究［J］.中华流行病学杂志，2002，23(1)：10-15.
［12］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.
［13］Lewinnek GE，Lewis JL，Tarr R，et al.Dislocations after total hip-replacement arthroplastie［J］.J Bone Joint Surg (Am)，1978，60(2)：217-220.
［14］Hu Fei，Shang Xifu，Zhang Xianzuo，et al.Direct anterior approach in lateral position achieves superior cup orientation in total hip arthroplasty：a radiological comparative study of two consecutive series［J］.Int Orthop，2020，44(3)：453-459.
［15］Little NJ，Busch CA，Gallagher JA，et al.Acetabular polyethylene wear and acetabular inclination and femoral offset［J］.Clin Orthop Relat Res，2009(467)：2895-2900.
［16］Langston J，Pierrepont J，Gu Y，et al.Risk factors for increased sagittal pelvic motion causing unfavourable orientation of the acetabular component in patients undergoing total hip arthroplasty［J］.Bone Joint J，2018，100B(7)：845-852.
［17］忻慰，王波，陈宜，等.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.
［18］Wilson JM，Schwartz AM，Farley KX，et al.Postoperative acetabular component position in revision hip arthroplasty：a comparison of the anterior and posterior approaches［J］.Hip Int，2020(17)：1120700020942451.
［19］Abdel MP，von Roth P，Jennings MT，et al.What safe zone? The vast majority of dislocated THA are within the lewinnek safe zone for acetabular component position［J］.Clin Orthop Relat Res，2016(474)：386-391.
［20］Jacobs CA，Kusema ET，Keeney BJ，et al.Does the thigh circumference affect the positioning of the acetabular component when using the direct anterior approach in total hip arthroplasty?［J］.Bone Joint J，2019，101B(5)：529-535.
［21］Wernly D，Wegrzyn J，Lallemand G，et al.Total hip arthroplasty through the direct anterior approach with and without the use of a traction table：a matched-control，retrospective，single-surgeon study［J］.J Orthop Surg Res，2021，16(1)：45.
［22］Foissey C，Kenney R，Luceri F，et al.Greater trochanter fractures in the direct anterior approach：evolution during learning curve，risk factors and consequences［J］.Arch Orthop Trauma Surg，2021，141(4)：675-681.
［23］Ghijselings SGM，Driesen R，Simon JP，et al.Distal extension of the direct anterior approach to the hip：A cadaveric feasibility study［J］.J Arthroplasty，2017，32(1)：300-303.
［24］Hasler J，Flury A，Dimitriou D，et al.Is revision total hip arthroplasty through the direct anterior approach feasible?［J］.Arch Orthop Trauma Surg，2020，140(8)：1125-1132.
［25］Kurkis GM，Chihab S，Farley KX，et al.Anterior revision hip arthroplasty is associated with higher wound complications but fewer dislocations compared to posterior revision hip surgery［J］.J Arthroplasty，2021，36(1)：250-254.
［26］Siddiqi A，Alden KJ，Yerasimides JG，et al.Direct anterior approach for revision total hip arthroplasty：anatomy and surgical technique［J］.J Am Acad Orthop Surg，2020，29(5)：217-231.
［27］Pincus D，Jenkinson R，Paterson M，et al.Association between surgical approach and major surgical complications in patients undergoing total hip arthroplasty［J］.JAMA，2020，323(11)：1070-1076.
［28］Watts CD，Houdek MT，Wagner ER，et al.High risk of wound complications following direct anterior total hip arthroplasty in obese patients［J］.J Arthroplasty，2015，30(12)：2296-2298.
［29］Hartford JM，Graw BP，Frosch DL.Perioperative complications stratified by body mass index for the direct anterior approach to total hip arthroplasty［J］.J Arthroplasty，2020，35(9)：2652-2657.