直接前入路全髋关节置换的优势及学习曲线

doi:10.3969/j.issn.2095-4344.2775

中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (27): 4364-4369.doi: 10.3969/j.issn.2095-4344.2775

• 骨与关节综述 bone and joint review • 上一篇下一篇

直接前入路全髋关节置换的优势及学习曲线

刘天盛1，苏彬2

1天津医院关节外科，天津市 300211；2武警特色医学中心研究部，天津市 300162

收稿日期:2020-02-13 修回日期:2020-02-24 接受日期:2020-03-13 出版日期:2020-09-28 发布日期:2020-09-10
通讯作者: 苏彬，教授，武警特色医学中心研究部救援医学研究所(原武警后勤学院附属医院，天津武警医院)，天津市 300162
作者简介:刘天盛，男，1973年生，天津市人，汉族，2017年天津医科大学毕业，博士，副主任医师，主要从事关节外科方面的研究。
基金资助:
天津市科委支撑计划项目-天津市救援医学临床医学研究中心(15ZXLCSY00040)

Advantages and learning curve of direct anterior approach in total hip arthroplasty

Liu Tiansheng1, Su Bin2

1Department of Joint Surgery, Tianjin Hospital, Tianjin 300211, China; 2Research Department, Armed Police Special Medical Center, Tianjin 300162, China

Received:2020-02-13 Revised:2020-02-24 Accepted:2020-03-13 Online:2020-09-28 Published:2020-09-10
Contact: Su Bin, Professor, Research Department, Armed Police Special Medical Center, Tianjin 300162, China
About author:Liu Tiansheng, MD, Associate chief physician, Department of Joint Surgery, Tianjin Hospital, Tianjin 300211, China
Supported by:
the Tianjin Science and Technology Commission Support Program-Tianjin Rescue Medical Clinical Research Center, No. 15ZXLCSY00040

摘要/Abstract

摘要：

文题释义：

直接前入路全髋关节置换：利用阔筋膜张肌与缝匠肌及股直肌与臀中肌之间的肌肉间隙显露髋关节作为全髋关节置换手术入路的一种微创技术。

学习曲线：以横轴表示反复次数(探索次数)、以纵轴表示各种学习测试、学习过程的曲线。

背景：近年来，随着现代外科手术向着微创和“快速康复”的趋势发展，直接前入路开始受到骨科医师的青睐。

目的：从直接前入路发展历史、手术适应证及患者选择、手术方法、常见并发症、术式优点、学习曲线等作一综述，以期为髋关节置换的快速康复提供思路。

方法：检索PubMed、万方数据库、中国知网(CNKI)数据库1956至2020年收录的有关直接前入路全髋关节置换的文献，英文检索词为“minimally invasive，direct anterior approach，total hip arthroplasty，enhanced recovery after surgery，complication，learning curve”，中文检索词为“微创，直接前方入路，全髋关节置换术，快速康复，并发症，学习曲线”，最终纳入67篇文献进行归纳总结。

结果与结论：①髋关节直接前入路因其走行于肌筋膜间隙，而且是一个真正意义上的神经肌肉界面入路，理论上不伤及重要的肌肉与神经血管，是一个十分理想的微创手术入路；②虽然直接前入路具有康复快、患者术后痛苦小、住院时间短、患者满意度高的优点，但由于国内大部分术者都是从其他入路改变过来的，存在着学习曲线长、早期并发症高等缺点。

ORCID: 0000-0002-4061-2330(刘天盛)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 微创, 直接前方入路, 全髋关节置换术, 快速康复, 并发症, 学习曲线

Abstract:

BACKGROUND: With the trend of minimally invasive and “rapid rehabilitation” in modern surgery, direct anterior approach is preferred by orthopedic surgeon in recent years.

OBJECTIVE: To review the direct anterior approach’s history, surgical indications, patients’ selection, surgical methods, common complications, surgery advantages and learning curves, to provide ideas for the rapid rehabilitation of hip arthroplasty.

METHODS: PubMed, Wanfang database, and CNKI were retrieved for articles addressing total hip arthroplasty through direct anterior approach published from 1956 to 2020. Key words were minimally invasive, direct anterior approach, total hip arthroplasty, enhanced recovery after surgery, complication, learning curve” in Chinese and English. Finally, 67 articles met the criteria for review.

RESULTS AND CONCLUSION: (1) The direct anterior approach is an ideal minimally invasive surgical path because of it walks in the fascia gap and it is a truly neuromuscular interface with no damage to important muscles and nerve blood vessels. (2) Direct anterior approach has advantages of quicker recovery, less postoperative pain, short hospital stay and high patient satisfaction. However, because most doctors in our country have changed their surgical approach to direct anterior approach, direct anterior approach still has shortages, such as long learning curve and high rate of early complications.

Key words: minimally invasive, direct anterior approach, total hip arthroplasty, enhanced recovery after surgery, complication, learning curve

中图分类号:

刘天盛, 苏彬. 直接前入路全髋关节置换的优势及学习曲线[J]. 中国组织工程研究, 2020, 24(27): 4364-4369.

Liu Tiansheng, Su Bin. Advantages and learning curve of direct anterior approach in total hip arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(27): 4364-4369.

图/表（结果） 1

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直接前入路全髋关节置换的优势及学习曲线

Advantages and learning curve of direct anterior approach in total hip arthroplasty

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