Assessment of the Damage to Hip Abductor Muscles in Primary Total Hip Arthroplasty With a Minimally Invasive Anterolateral Approach With or Without Trochanteric Flip Osteotomy
Assessment of the Damage to Hip Abductor Muscles in Primary Total Hip Arthroplasty With a Minimally Invasive Anterolateral Approach With or Without Trochanteric Flip Osteotomy
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初次全髋关节置换术中采用微创前外侧入路伴或不伴转子翻转截骨术对髋关节外展肌损伤的评估
DOI：
10.1016/j.arth.2023.02.075
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Matsuda Shuichi
中科院分区：
文献类型：
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作者：
Takaoka Yusuke;Goto Koji;Kuroda Yutaka;Kawai Toshiyuki;Okuzu Yaichiro;Matsuda Shuichi
尽管经前外侧入路微创技术的引入显著减少了全髋关节置换术（THA）后的长时间跛行，但对外展肌的潜在损伤仍然是一个问题。本研究旨在通过评估脂肪浸润和臀中肌（GMed）和臀小肌（GMin）萎缩，评估两种前外侧入路初次THA后的残余损伤。通过用骨碎片分离外展肌的前部进行手术（前外侧入路加转子翻转截骨术）或不加（前外侧入路不加转子翻转截骨术）。结果术后1年，86%和81%的患者GMed的放射密度（RD）和横截面积（CSA）分别增加，而GMin的RD和CSA分别下降71%和94%。GMed的RD改善更多见于后部而非前部，而GMin在两个部分均下降。前外侧入路加粗隆翻转截骨术组的GMin的RD降低显著低于前外侧入路不加粗隆翻转截骨术组（P= 0.0250）。然而，两组之间的临床评分没有差异。GMed的RD的变化是唯一与临床scores.ConclusionTwo前外侧入路均改善了GMed的RD，其恢复与术后临床评分显著相关。尽管两种方法在THA后1年内显示出不同的GMin恢复模式，但两种方法在临床评分方面的改善相似。
BackgroundAlthough introduction of minimally invasive techniques via anterolateral approaches considerably decreased prolonged limp after total hip arthroplasty (THA), potential damage to the abductor muscles is still a concern. This study aimed to evaluate the residual damage after primary THA with two types of anterolateral approach by assessing fatty infiltration and atrophy of the gluteus medius (GMed) and gluteus minimus (GMin) muscles.MethodsWe retrospectively analyzed 100 primary THAs using computed tomography; surgeries were performed by detaching the anterior part of the abductor muscles with a bone fragment (anterolateral approach with trochanteric flip osteotomy) or without it (anterolateral approach without trochanteric flip osteotomy). The change in radiodensities (RDs), cross-sectional areas (CSAs), and clinical scores preoperatively and at 1 year after operation were evaluated.ResultsThe RD and CSA of GMed increased 1 year postoperatively in 86 and 81% of patients, respectively, while RD and CSA of GMin decreased in 71 and 94%, respectively. The improvement of RD of GMed was more frequently seen in the posterior rather than the anterior part, while the GMin decreased in both parts. The RD decrease of GMin was significantly lower in the anterolateral approach with trochanteric flip osteotomy group than the anterolateral approach without trochanteric flip osteotomy group (P= .0250). However, there was no difference in the clinical scores between the two groups. The change in the RD of GMed was the only factor that correlated with clinical scores.ConclusionThe two anterolateral approaches both improved the RD of GMed, recovery of which was significantly associated with postoperative clinical scores. Although the two approaches showed different recovery patterns in GMin until 1 year after THA, both showed similar improvements in clinical scores.