Total hip arthroplasty in lateral decubitus position based on direct anterior minimum invasive surgery

doi:10.3969/j.issn.2095-4344.0157

Abstract

Abstract:

BACKGROUND: Direct anterior minimum invasive surgery (DAMIS) total hip arthroplasty has been considered as the total hip arthroplasty that is most consistent with the minimally invasive standards. In theory, there is a low incidence of complications in the DAMIS total hip arthroplasty. However, because minimally invasive surgery demands high surgery skills, the incidence rate of complications is high in the early period of its learning curve. Lateral decubitus position DAMIS was considered to provide a better perspective, so that, the incidence of surgical complications may be reduced.

OBJECTIVE: To explore the feasibility of lateral decubitus position DAMIS for total hip arthroplasty.

METHODS: Totally 62 cases from the Department of Orthopedics, First Affiliated Hospital of Gannan Medical University between April 2013 and April 2016 were retrospectively analyzed, and randomly assigned to two groups: lateral decubitus position group (n=31) and supine position group (n=31). Incision length, operative time, intraoperative blood loss, acetabular cup angle, hospital stay, Harris scores, Visual Analogue Scale score, and SF-36 score were compared between the two groups. Complications at postoperative 1 year were recorded.

RESULTS AND CONCLUSION: (1) Operative time was longer and intraoperative blood loss was more in the lateral decubitus position group than in the supine position group (P < 0.05). There were no statistically significant differences in incision length and hospital stay between the two groups (P > 0.05). (2) There were no significant differences in the incidence of postoperative complications between the two groups (P > 0.05). (3) There were no significant differences in the anteversion and abduction angles of acetabular cup between the two groups (P > 0.05). (4) There were no significant differences in Harris hip score, Visual Analogue Scale score, and SF-36 the quality of life scores between the two groups before surgery and 1 year after surgery (P > 0.05). (5) In conclusion, DAMIS total hip arthroplasty can abandon special traction bed when patients are in lateral decubitus position. The short-term effects are the same with supine DAMIS total hip arthroplasty.

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

Key words: Arthroplasty, Replacement, Hip, Supine Position, Surgical Procedures, Minimally Invasive, Tissue Engineering

CLC Number:

R318

Ye Shan-shan, Gao Hui, Zhang Yu, He Chun-lei. Total hip arthroplasty in lateral decubitus position based on direct anterior minimum invasive surgery[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(11): 1647-1652.

Figures/Tables 2

2.2 基线资料比较 2组患者的人口学基线资料和术前临床特征比较差异无显著性意义(P > 0.05)，2组病例具有可比性，见表1。 2.3 围手术期观察指标比较手术相关指标结果经两独立样本t 检验比较，侧卧位组手术时间比仰卧位组长(P < 0.05)，术中出血量大于仰卧位组(P < 0.05)，其余结果差异未见显著性意义(P > 0.05)，见表2。 2.4 术后并发症发生情况比较观察2组病例围手术期及术后1年中发生的并发症，近、远期严重并发症发生率均较低。2组病例均未观察到深部感染、深静脉血栓形成、肺栓塞、臼杯松动、股骨柄、假体周围骨折，统计结果不在表中赘述。比较结果见表3。 2.5 术后臼杯角度散点分布图研究人员根据Pradhan [15]制定的臼杯角度测量方法测定臼杯角度。通过绘制散点图并结合Lewinnek等[16]制定的安全区域框，可得侧卧位组90.3%落于安全区域内(图3)。仰卧位组93.5%落于安全区域内。结果经卡法检验，差异无显著性意义(P > 0.05)。2组患者臼杯前倾角、外展角及安全角度组合数比较见表4。2组前倾角、外展角及安全角度组合差异均无显著性意义，说明不同体位对置入臼杯的角度影响较小。 2.6 术后评分比较研究小组定期对2组患者进行了Harris髋关节功能评分、SF-36生活质量评分、目测类比疼痛评分的调查，发现各时期结果差异无显著性意义(P > 0.05)。其中Harris评分结果显示，2组患者的髋关节功能在12个月之后均达到优良水平(图4)；2组患者的生活质量较术前均有显著提高；全髋关节置换显著降低了2组患者的疼痛感，结果见表5。 2.7 不良事件 2组各发现1例切口轻微感染，经消毒换药，切口愈合，未造成更多感染。未见血压骤升、症状性的肺栓塞和下肢深静脉血栓形成等不良事件。 "

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