背景:用于全髋关节置换术的微创方法,例如DAA(“带比基尼切口的直接前入路”)越来越多地被使用。根据文献,这种方法更节省肌肉,减少术后疼痛,达到更高的患者满意度。很少考虑髋关节置换术后淋巴水肿的存在。本文的目的是为评估与术后淋巴水肿相关的不同进入方法及其功能结局做出贡献。
方法:这是一项在北欧骨科专科诊所进行的前瞻性非随机研究。进行关节置换术的外科医生是该诊所附属的私人诊所中的大量外科医生。该研究包括188例初次髋关节置换术患者,比例为1:1(DAA:标准入路(后,跨臀肌,和前外侧通道)。流行病学数据,哈里斯髋关节得分,牛津髋关节评分,术前入院当天收集欧洲生活质量5和视觉模拟量表,术后第3天和第5天,1年后随访。此外,运动范围,步态,和爬楼梯的能力,以及是否存在感觉减退进行了评估。评估水肿情况,在术后第3天和第5天测量双腿.记录手动淋巴引流的处方和术后1年的肿胀情况。
结果:对于每组,纳入94例患者,平均年龄61.7岁(DAA60.7和标准访问62.6)。DAA组中,除一名患者外,所有患者均显示术后淋巴水肿(n:93/94;98.9%)。在标准手术组中,只有n:37/94(39.4%)出现需要治疗的肿胀症状.一年后,DAA组20例患者和标准OR组0例患者淋巴水肿持续存在.12个月后,DAA组16/94(=17%)患者的大腿腹侧感觉减退持续存在,而标准组的0/94患者则持续存在。在这16个案例中,10例伴有水肿(62.5%)。在牛津髋关节评分(p<0.05)和爬楼梯能力(p<0.05)方面,DAA显示出比标准通道更好的结果。相比之下,视觉模拟量表与患者生活质量结果无显著性差异(p>0.05)。
结论:本研究表明,使用比基尼型皮肤切口通过DAA手术的患者术后淋巴水肿的发生率增加。在后续行动中,DAA组发生的大腿腹侧感觉减退明显增多。否则,从短期随访的功能角度来看,DAA被证明优于标准方法。对于本研究中发现的上述不良反应,需要进一步的研究来比较直接前髋手术中的水平倾斜和纵向倾斜皮肤切口技术。
BACKGROUND: Minimally invasive approaches to the hip joint for total hip arthroplasty such as the DAA (\"Direct Anterior Approach with bikini incision\") are increasingly utilized. According to the literature, this approach is more muscle-sparing, results in less postoperative pain, and achieves higher patient satisfaction. The existence of postoperative lymphedema after hip arthroplasty is hardly considered. The aim of this paper is to contribute to the evaluation of the different access methods related to postoperative lymphedema and their functional outcomes.
METHODS: This is a prospective non-randomized study at an orthopedic specialist clinic in Northern Europe. The surgeons that performed the arthroplasties are high-volume surgeons in private practice affiliated to the clinic. The study included 188 patients with primary hip arthroplasty in a 1:1 ratio (DAA: standard accesses (posterior, transgluteal, and anterolateral access)). Epidemiologic data, Harris Hip Score, Oxford Hip Score, European Quality of Life 5, and Visual Analog Scale were collected preoperatively on admission day, 3rd and 5th postoperative day, and follow-up after 1 year. Furthermore, the range of motion, gait, and ability to climb stairs, as well as the presence of hypesthesia were assessed. To evaluate the edema situation, both legs were measured on the 3rd and 5th postoperative day. The prescription of manual lymphatic drainage and remaining swelling conditions 1 year postoperatively were recorded.
RESULTS: For each group, 94 patients with a mean age of 61.7 years (DAA 60.7 and standard access 62.6) were included. All but one patient in the DAA group showed postoperative lymphedema (n: 93/94; 98.9%). In the standard surgery group, only n: 37/94 (39.4%) showed swelling symptoms requiring treatment. After 1 year, lymphedema persisted in 20 patients in the DAA group and 0 patients in the standard-OR group. Hypesthesia at the ventral thigh persisted in 16/94 (= 17%) patients of the DAA group versus 0/94 patients of the standard group after 12 months. Of these 16 cases, 10 had concomitant edema (62.5%). The DAA showed better results than the standard accesses in terms of Oxford Hip Score (p < 0.05) and ability to climb stairs (p < 0.05). In contrast, the Visual Analog Scale and patient quality of life results showed no significant difference (p > 0.05).
CONCLUSIONS: The present study demonstrated the increased incidence of postoperative lymphedema in patients operated on via DAA access using a Bikini-type skin incision. In the follow-up, significantly more hypesthesia of the ventral thigh occurred in the DAA group. Otherwise, the DAA proved to be superior to the standard approaches from a functional point of view at short-term follow-up. Future research is needed to compare the horizontally oblique to the longitudinal oblique skin incision technique in direct anterior hip surgery regarding the above-mentioned adverse effects found in this study.