背景:直接前入路由于其微创性和快速恢复时间而越来越多地用于初次全髋关节置换术(THA)。在手术过程中,很难确定正确的肌肉间期,有时会导致过度的内侧暴露。本研究旨在评估人口统计学和危险因素,结果,以及那些采用中介方法的THA患者的潜在并发症。
方法:我们回顾性回顾了前THA的病例,以确定髋部手术入路比标准间隔更内侧的病例。人口统计数据,手术时间,失血,术中和术后并发症,收集影像学检查结果,并与使用标准前肌间间期进行50次THA的对照组进行比较.
结果:在2018年1月至2021年12月之间进行的1,450例前全髋关节置换术(THA)手术中,平均随访时间为33±22.3个月,6例患者(0.4%)的手术间期达到中等.在一种情况下,浅层位于健美肌肉的内侧,而在其他五种情况下,从表面上看,间隔是横向的,位于股直肌的内侧。6例患者中有4例(66.6%)表现为影响股神经的神经利用,6人中有3人(50%)股外侧皮神经受累。6名患者中有6名(100%)在DAA的学习曲线期间进行手术。对照组无患者出现股神经神经错用,50例患者中有2例(4%)表现出股外侧皮神经受累。
结论:前路很少会导致髋关节内侧过度暴露,尤其是在学习曲线期间。在我们的研究队列中,观察到神经系统并发症的发生率增加,结局降低,从而使该事件具有特定的临床意义。为了避免非常规的肌肉间隔,患者定位和通过识别肌肉纤维的方向来正确识别肌肉腹部是有用的,连同回旋血管的识别和结扎,以确保识别正确的肌间间隔。
BACKGROUND: The direct anterior approach is increasingly used for primary total hip arthroplasty (
THA) due to its minimally invasive nature and rapid recovery time. Difficulties in identifying the correct intermuscular interval can arise during the procedure, sometimes resulting in excessive medial exposure. This study aimed to evaluate demographics and risk factors, outcomes, and potential complications in those
THA patients in which a medialized approach was performed.
METHODS: We retrospectively reviewed cases of anterior
THA to identify cases where the surgical approach to the hip was more medial than the standard interval. Demographic data, operative time, blood loss, intraoperative and postoperative complications, radiographic findings were collected and compared with a control group of 50
THA performed using the standard anterior intermuscular interval.
RESULTS: In a series of 1,450 anterior total hip arthroplasty (
THA) procedures performed between January 2018 and December 2021, with an average follow-up of 33 ± 22.3 months, six patients (0.4%) had a medialized surgical interval. In one case the superficial layer was medial to the sartorious muscle while in the other five cases, the interval was lateral to the sartorius superficially, and medial to the rectus femoris deeply. Four out of 6 patients (66.6%) showed neuropraxia affecting the femoral nerve, and 3 out of 6 (50%) had involvement of the lateral femoral cutaneous nerve. In 6 out of 6 patients (100%), surgery was performed during the learning curve of DAA. No patients in the control group developed femoral nerve neuropraxia, and 2 out of 50 patients (4%) showed involvement of the lateral femoral cutaneous nerve.
CONCLUSIONS: The anterior approach can rarely result in excessive medial exposure to the hip joint, especially during the learning curve. In our study cohort, an increased rate of neurological complications and reduced outcomes were observed, thereby rendering this event of particular clinical significance. To avoid unconventional intermuscular intervals, patient positioning and correct identification of the muscle bellies by recognizing the orientation of the muscle fibers are useful, together with the identification and ligation of the circumflex vessels, to ensure the identification of the correct intermuscular interval.