Bikini 切口直接前方入路全髋关节置换近期结果

Short-term outcomes of Bikini incision for direct anterior approach in total hip arthroplasty

[目的]评价侧卧位Bikini切口直接前方入路(direct anterior approach,DAA)全髋关节置换术(total hip arthroplasty,THA)的临床效果。[方法]回顾性分析2018年1月—2020年1月,采用Bikini切口DAA入路THA的40例患者,总结围手术期、随访和影像资料。[结果]40例患者均顺利手术,术中无血管、神经损伤,无骨折。3例患者术后股前外侧麻木,或伸膝无力,给予神经营养药物,于术后6个月症状基本消失,不影响功能。所有患者均无切口深部感染、症状性下肢静脉血栓等并发症。40例患者随访12个月以上。与术前相比,末次随访时VAS评分显著下降(P<0.05),而Harris评分显著增加(P<0.05)。末次随访时,40例患者均无明显切口瘢痕增生,切口处无压痛。术后影像显示40例患者髋臼和股骨假体位置良好。至末次随访时,无假体松动征象。[结论]侧卧位Bikini切口DAA入路THA临床效果满意,特别是切口外观良好,但此入路仍有神经牵拉损伤的风险。

[Objective]To evaluate the clinical outcomes of total hip arthroplasty(THA)by Bikini incision for direct anterior approach(DAA)in lateral position.[Methods]A retrospective study was conducted on 40 patients who had THA performed by Bikini incision for DDA approach from January 2018 to January 2020.The perioperative,follow-up and imaging data were summarized in this paper.[Re⁃sults]All the 40 patients had THA performed successfully without vascular or nerve injury,or fracture during the operation.Of them,3 pa⁃tients had postoperative numbness in the anterolateral thigh,or weakness in extension of the knee,and were given neurotrophic drugs.The symptoms disappeared at 6 months after the operation,without functional impairment of the affected limbs in the 3 patients.All patients had no complications,such as deep incision infections,and symptomatic deep venous thrombosis of the lower extremity.All the 40 patients were followed up for more than 12 months.Compared with those preoperatively,the VAS score decreased significantly(P<0.05),while the Harris score increased significantly at the latest follow up(P<0.05).None of the 40 patients had obvious incision scar hyperplasia with ten⁃derness at the incision at the latest follow-up.Postoperative images showed that the acetabular and femoral components were in good posi⁃tion in all the 40 patients.By the time of latest follow-up,no signs of prosthetic loosening were noted in anyone of them.[Conclusion]The THA through Bikini incision for DAA approach in lateral position does achieve satisfactory clinical outcomes,especially the good appear⁃ance of the incision.However,this approach still has the risk of nerve traction injury.