Direct anterior versus anterolateral approach in one-stage supine total hip arthroplasty. Focused on nerve injury: A prospective, randomized, controlled trial
Direct anterior versus anterolateral approach in one-stage supine total hip arthroplasty. Focused on nerve injury: A prospective, randomized, controlled trial
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DOI：
10.1016/j.jos.2018.05.005
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发表时间：
2018-09-01
影响因子：
1.7
通讯作者：
Okawa, Atsushi
中科院分区：
文献类型：
--
作者：
Takada, Ryohei;Jinno, Tetsuya;Okawa, Atsushi
背景：全髋关节置换术（THA）的直接前入路（DAA）和前外侧入路（ALA）的临床结果差异仍不清楚。本研究的目的是在一项前瞻性、随机对照试验中比较 DAA 和 ALA 在一期双侧 THA 中的临床结果，包括神经损伤。方法：2014 年至 2016 年招募 30 例初次双侧 THA 患者。每位患者的左右髋部被随机分配至 DAA，其余髋部分配至 ALA。我们前瞻性地比较了两种入路的临床结果、股外侧皮神经（LFCN）损伤的发生率以及被认为与臀上神经损伤相关的阔筋膜张肌（TFL）萎缩的发生率。结果：术后1年两侧的临床结果没有发现显着差异。仅在 DAA 侧观察到 LFCN 损伤的暂时症状（7/30，23.3%）。接受 DAA 侧（DAA 侧，78.8 +/- 22.8%）的计算机断层扫描术后 3 个月与术前 TFL 横截面积之比显着低于接受 ALA 侧（ALA 侧，90.7 +/- 17.7%）（p < 0.01）。术后 1 年磁共振成像显示，根据 Goutalier 分级，DAA 侧 TFL 脂肪萎缩平均等级 (2.00 +/- 1.6) 显着高于 ALA 侧 (1.1 +/- 1.3) (p = 0.03)。结论：DAA 和 ALA 均取得了优异的临床效果。仅在 DAA 侧发现 LFCN 损伤。虽然两种方法均发现 TFL 萎缩，但 DAA 侧的萎缩明显更多。我们的研究表明，就神经损伤的风险而言，应使用 ALA 而不是 DAA。 (C) 2018 日本骨科协会。由 Elsevier B.V. 出版。保留所有权利。
Background: The difference in clinical results between the direct anterior approach (DAA) and the anterolateral approach (ALA) for total hip arthroplasty (THA) is still unclear. The purpose of this study was to compare clinical results, including nerve injuries, between DAA and ALA in one-stage bilateral THA in a prospective, randomized controlled trial.Methods: Thirty patients were recruited for primary bilateral THAs from 2014 to 2016. The left and right hips of each patient were randomly assigned to DAA and the others to ALA. We prospectively compared the clinical results, incidence of lateral femoral cutaneous nerve (LFCN) injury, and tensor fascia lata (TFL) atrophy considered to be related to superior gluteal nerve injury between both approaches.Results: No significant difference was found in the clinical results between both sides at postoperative 1 year. Temporary symptom of LFCN injury was observed only in DAA sides (7/30, 23.3%). The ratio of 3-month postoperative to preoperative cross-sectional area of TFL on computed tomography was significantly lower on the side subjected to DAA (DAA side, 78.8 +/- 22.8%) than on the side subjected to ALA (ALA side, 90.7 +/- 17.7%) (p < 0.01). In magnetic resonance imaging at postoperative 1 year, the mean grade of fatty atrophy of TFL by Goutalier classification was significantly higher in DAA sides (2.00 +/- 1.6) than in ALA sides (1.1 +/- 1.3) (p = 0.03).Conclusions: Excellent clinical results for both DAA and ALA were achieved. LFCN injury was found only in DAA sides. Although TFL atrophy was found in both approaches, it was found significantly more in DAA sides. Our study suggested that ALA should be used rather than DAA in terms of the risk of nerve injuries. (C) 2018 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.