Surgical approach, abductor function, and total hip arthroplasty dislocation
Surgical approach, abductor function, and total hip arthroplasty dislocation
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DOI：
10.1097/01.blo.0000038476.05771.6c
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发表时间：
2002-12-01
影响因子：
4.2
通讯作者：
Bourne, RB
中科院分区：
文献类型：
--
作者：
Masonis, JL;Bourne, RB
脱位是全髋关节置换术的主要早期并发症。手术入路对不稳定性和外展肌功能的影响是一个有争议的话题。我们对手术入路与原发性全髋关节置换术脱位的相关性进行了全面的文献回顾。在1970年到2001年间，有260项临床研究被确认。我们确定了四项前瞻性研究，但它们各自的效力或对照组不足，无法在手术入路和脱位方面达到统计学意义。14项涉及13,203例初次全髋关节置换术的研究符合先前显示的影响稳定性的变量的纳入标准。这些研究对手术入路和脱位进行了评估。这些研究的综合脱位率经粗隆入路为1.27%，后路为3.23%（无后路修复3.95%，后路修复2.03%），前外侧入路为2.18%，直接外侧入路为0.55%。8项涉及2455例原发性全髋关节置换术的研究评估了术后跛行。侧入路患者术后跛行发生率为4% ~ 20%，后路患者为0% ~ 16%。关于手术入路、脱位率和外展肌功能的文献质量有限。需要更大规模的前瞻性对照研究来研究后路入路替代脱位率比直接外侧入路高6倍的原发性全髋关节置换术的潜在益处。
Dislocation is a leading early complication of total hip arthroplasty. The effect of surgical approach on instability and abductor function is a controversial topic. A comprehensive literature review was done to evaluate the correlation of surgical approach and primary total hip arthroplasty dislocation. Two hundred sixty clinical studies were identified between 1970 and 2001. Four prospective studies were identified but individually they contained insufficient power or control groups to reach statistical significance regarding surgical approach and dislocation. Fourteen studies involving 13,203 primary total hip arthroplasties met the inclusion criteria based on variables previously shown to affect stability. These studies were evaluated with respect to surgical approach and dislocation. The combined dislocation rate for these studies was 1.27% for the transtrochanteric approach, 3.23% for the posterior approach (3.95% without posterior repair and 2.03% with posterior repair), 2.18% for the anterolateral approach, and 0.55% for the direct lateral approach. Eight studies involving 2455 primary total hip arthroplasties evaluated postoperative limp. The incidence of postoperative limp was 4% to 20% for patients who had the lateral approach and 0% to 16% for patients who had the posterior approach. The quality of the literature regarding surgical approach, dislocation rates, and abductor function is limited. Larger controlled prospective studies are needed to investigate the potential benefits of the posterior approach in lieu of a dislocation rate six times higher than the direct lateral approach for primary total hip arthroplasty.