来源：304关节学术

译者：马云青

整理：骨科在线

来自美国的Angerame MR, Fehring TK, Masonis JL等2018年发表于《J Arthroplasty》杂志的一项研究显示，在初次全髋关节置换手术（THA）中，使用直接前入路(DAA)术后有较高的股骨假体松动率，而使用后外侧入路(PA)术后有较高的脱位翻修率。总翻修率在各入路之间没有统计学差异。

在THA手术方式创新的时代，各种的手术入路被医师所选择，而人们担心早期失败的趋势也越来越大。因此作者旨在通过本研究评估不同手术入路的初次THA患者早期失败的发生率。

研究人员对2007年至2014年在病例数较多的关节中心连续完成的初次THA病例进行回顾性研究。通过不同手术入路对THA进行分组。包括直接前路(DAA)和后外侧入路(PA)。主要评价结果是早期翻修(术后5年内)。使用SAS软件进行描述性统计评价。

结果显示，2007年至2014年间，总共有6894例初次THA。在2431个DAA THAS和4463个PA THAS中，共有103例接受了翻修。与PA THAs（1.39%）相比(P=0.33，DAA THAs的总体翻修率（1.69%）没有差异。与PA相比(P=0.0003)DAA组股骨假体松动导致的早期翻修率较高。约35.7%的DAA THAs由于股骨假体松动而接受翻修，而8%PA因股骨假体松动而翻修的仅占8%(P=0.0003)。在Dorr A型股骨近端解剖类型中，股骨假体松动导致的早期失败更多见于DAA入路（P=0.03)。PA翻修的主要原因是关节不稳定(P=0. 04)。在假体失败时间、髋臼松动率、早期假体周围骨折或感染方面无差异。

原文摘要：

Early Failure of Primary Total Hip Arthroplasty: Is Surgical Approach a Risk Factor?

Background: In an era of innovation in surgical approaches for total hip arthroplasty (THA), there is concern for increasing trends of early failure. The purpose of this study is to evaluate the incidence of early failure of primary THA stratified by surgical approach.

Methods: A retrospective review was performed on consecutive primary THAs completed from 2007 to 2014 at a high-volume center. THAs were stratified by surgical approach. Only the direct anterior (DAA) and posterior approaches (PA) were included. The primary outcome measure was early revision (<5 years). Descriptive statistics were performed using SAS software.

Results: In total, 6894 primary THAs performed between 2007 and 2014 were included. Across 2431 DAA THAs and 4463 PA THAs, there were 103 revisions overall. There was no difference in the overall revision rate for DAA THAs (1.69%) compared to PA THAs (1.39%) (P = .33). The DAA had a higher rate of early revisions for femoral component loosening compared to the PA (P = .0003). About 35.7% of DAA THAs were revised for femoral loosening compared to 8% for the PA (P = .0003). Early failure by femoral loosening occurred more often via the DAA in Dorr A bone (P = .03). The PA had a higher incidence of revision for instability (P = .04). There was no difference in modes of failure with regards to time to failure, acetabular loosening, early periprosthetic fracture, or infection.

Conclusion: The DAA had a higher incidence of femoral loosening while PA had a higher mode of failure due to instability. Overall revision rates were not statistically different between approaches.

文献出处：Angerame MR, Fehring TK, Masonis JL, Mason JB, Odum SM, Springer BD. Early Failure of Primary Total Hip Arthroplasty: Is Surgical Approach a Risk Factor? J Arthroplasty. 2018 Jun;33(6):1780-1785. doi: 10.1016/j.arth.2018.01.014. Epub 2018 Feb 2. PMID: 29439894.