背景:手术方式影响全髋关节置换术(THA)后的结果和恢复,和方法可能会影响茎的定位。与微创手术的一般概念相反,直接前路(DAA)导致更多的术中失血。因此,这项研究的目的是比较三种手术方法中的茎定位和隐性失血(HBL):微创DAA,OrthopadischeChirurgieMunchen(OCM),和传统的后外侧入路(PLA)。
方法:共有201例患者使用DAA进行首次非水泥THA,OCM,和PLA被纳入研究。一般人口统计数据,阀杆对齐,并对失血量进行了评估。具体比较测量包括股骨颈前倾,股骨干前倾,茎在冠状面和矢状面上的对齐,近端和远端髓质比率,和股骨偏移。通过计算术中失血量(IBL)来测量失血量,可见失血(VBL),隐性失血(HBL)
结果:年龄没有显著差异,性别,身体质量指数,术前诊断,或股骨Dorr分类。与PLA相比,DAA和OCM的平均手术时间更长(P<0.01)。DAA组IBL最高,PLA组最低(P<0.05)。术后茎前倾在各组间有显著差异,DAA表现出最大的前倾差异(P<0.05)。茎冠状排列没有差异。然而,DAA和OCM矢状面有更多的外翻和内翻植入物。DAA和OCM组的股骨偏移减少效果较差(P<0.05)。DAA和OCM的近端和远端髓质比率较低(P<0.05)。与PLA相比,DAA和OCM中的HBL显著降低(P<0.05)。
结论:DAA和OCM等微创方法在肌肉和软组织保存方面具有优势,与常规PLA相比,导致HBL降低。然而,这些方法在股骨柄定位和更长的手术时间方面存在挑战.
BACKGROUND: The surgical approach impacts the outcomes and recovery after total hip arthroplasty (THA), and approaches may affect the stem positioning. Contrary to the general concept of minimally invasive surgery, the direct anterior approach (DAA) results in more intraoperative blood loss. Therefore, the objective of this study was to compare stem positioning and hidden blood loss (HBL) among three surgical approaches: the minimally invasive DAA, Orthopadische Chirurgie Munchen (OCM), and the traditional posterolateral approach (PLA).
METHODS: A total of 201 patients undergoing their first non-cemented THA using the DAA, OCM, and PLA were included in the study. General demographic data, stem alignment, and blood loss were evaluated. Specific comparison measurements included femoral neck anteversion, femoral stem anteversion, alignment of the stem in coronal and sagittal planes, proximal and distal medullary ratios, and femoral offset. Blood loss was measured by calculating Intraoperative Blood Loss ( IBL), visible blood loss (VBL), and hidden blood loss (HBL).
RESULTS: There were no significant differences in age, gender, body mass index, preoperative diagnosis, or femoral Dorr classification among the three groups. The mean surgical time was longer for the DAA and OCM compared to the PLA (P < 0.01). IBL was highest in the DAA group and lowest in the PLA (P < 0.05). Postoperative stem anteversion were significantly different among the groups, with the DAA showing the greatest anteversion difference (P < 0.05). There was no difference in the stem coronal alignment. However, there were more valgus and varus implants in the sagittal plane for the DAA and OCM. The femoral offset reduction was less optimal in the DAA and OCM groups (P < 0.05). The proximal and distal medullary ratios were lower in the DAA and OCM (P < 0.05). HBL was significantly lower in the DAA and OCM compared to the PLA (P < 0.05).
CONCLUSIONS: Minimally invasive approaches such as DAA and OCM offer advantages in muscle and soft tissue preservation, leading to reduced HBL compared to the conventional PLA. However, these approaches present challenges in femoral stem positioning and longer surgical times.