AIM: To evaluate whether walking ability recovers early after bipolar hemiarthroplasty(BHA) using a direct anterior approach.METHODS: Between 2008 and 2010, 81 patients with femoral neck fracture underwent BHA using t...AIM: To evaluate whether walking ability recovers early after bipolar hemiarthroplasty(BHA) using a direct anterior approach.METHODS: Between 2008 and 2010, 81 patients with femoral neck fracture underwent BHA using the direct anterior approach(DAA) or the posterior approach(PA). The mean observation period was 36 mo. The age, sex, body mass index(BMI), time from admission to surgery, length of hospitalization, outcome after discharge, walking ability, duration of surgery, blood loss and complications were compared. RESULTS: There was no significant difference in the age, sex, BMI, time from admission to surgery, length of hospitalization, outcome after discharge, duration of surgery and blood loss between the two groups. Two weeks after the operation, assistance was not necessary for walking in the hospital in 65.0% of the patients in the DAA group and in 33.3% in the PA group(P < 0.05). As for complications, fracture of the femoral greater trochanter developed in 1 patient in the DAA group and calcar crack and dislocation in 1 patient each in the PA group.CONCLUSION: DAA is an approach more useful for BHA for femoral neck fracture in elderly patients than total hip arthroplasty in terms of the early acquisition of walking ability.展开更多
背景:经直接前入路(DAA)行全髋关节置换术(THA)的疗效及安全性尚不明确。目的:应用系统评价及meta分析的方法评价度过学习曲线后DAA和后方入路(PA)对THA疗效及安全性的影响。方法:计算机检索各数据库内关于DAA与PA对THA疗效及安全性影...背景:经直接前入路(DAA)行全髋关节置换术(THA)的疗效及安全性尚不明确。目的:应用系统评价及meta分析的方法评价度过学习曲线后DAA和后方入路(PA)对THA疗效及安全性的影响。方法:计算机检索各数据库内关于DAA与PA对THA疗效及安全性影响的对照试验,按照既定的纳入、排除标准检出文献,严格评价纳入研究的方法学质量并提取数据,采用Rev Man 5.2软件对可以合并分析的指标进行meta分析,对不能合并的指标采用描述性分析。结果:纳入文献11篇,共入选患者1612例,其中DAA组817例,PA组795例。DAA组患者术后需使用助行设备的时间明显短于PA组(WMD=-11.05,95%CI:-17.79^-4.31,P=0.001)。描述性分析发现DAA在术后早期功能恢复以及活动能力上优于PA。两组术中及术后1年的并发症发生率(OR=1.48,95%CI:0.69~3.20,P=0.32)、术中骨折发生率(OR=1.31,95%CI:0.50~3.45,P=0.58)、术后脱位发生率(OR=0.34,95%CI:0.09~1.28],P=0.11)、异位骨化发生率(OR=1.01,95%CI:0.26~3.94,P=0.99)、腹股沟区疼痛发生率(OR=2.73,95%CI:0.62~12.06],P=0.19)均无统计学差异。而且两组的手术时间(WMD=10.25,95%CI:-6.33~26.83],P=0.23)、住院时间(WMD=-0.34,95%CI:-0.76~0.07],P=0.10)、Lewinnek安全区内髋臼假体的数量(OR=2.08,95%CI:0.65~6.72,P=0.22)也无统计学差异。同时,DAA具有预防术后脱位的潜在优势,DAA术中使用X线透视会避免出现明显异常的髋臼假体位置。结论:在熟练掌握DAA THA技术的前提下,DAA是具有一定优势的手术入路。展开更多
文摘AIM: To evaluate whether walking ability recovers early after bipolar hemiarthroplasty(BHA) using a direct anterior approach.METHODS: Between 2008 and 2010, 81 patients with femoral neck fracture underwent BHA using the direct anterior approach(DAA) or the posterior approach(PA). The mean observation period was 36 mo. The age, sex, body mass index(BMI), time from admission to surgery, length of hospitalization, outcome after discharge, walking ability, duration of surgery, blood loss and complications were compared. RESULTS: There was no significant difference in the age, sex, BMI, time from admission to surgery, length of hospitalization, outcome after discharge, duration of surgery and blood loss between the two groups. Two weeks after the operation, assistance was not necessary for walking in the hospital in 65.0% of the patients in the DAA group and in 33.3% in the PA group(P < 0.05). As for complications, fracture of the femoral greater trochanter developed in 1 patient in the DAA group and calcar crack and dislocation in 1 patient each in the PA group.CONCLUSION: DAA is an approach more useful for BHA for femoral neck fracture in elderly patients than total hip arthroplasty in terms of the early acquisition of walking ability.
文摘背景:经直接前入路(DAA)行全髋关节置换术(THA)的疗效及安全性尚不明确。目的:应用系统评价及meta分析的方法评价度过学习曲线后DAA和后方入路(PA)对THA疗效及安全性的影响。方法:计算机检索各数据库内关于DAA与PA对THA疗效及安全性影响的对照试验,按照既定的纳入、排除标准检出文献,严格评价纳入研究的方法学质量并提取数据,采用Rev Man 5.2软件对可以合并分析的指标进行meta分析,对不能合并的指标采用描述性分析。结果:纳入文献11篇,共入选患者1612例,其中DAA组817例,PA组795例。DAA组患者术后需使用助行设备的时间明显短于PA组(WMD=-11.05,95%CI:-17.79^-4.31,P=0.001)。描述性分析发现DAA在术后早期功能恢复以及活动能力上优于PA。两组术中及术后1年的并发症发生率(OR=1.48,95%CI:0.69~3.20,P=0.32)、术中骨折发生率(OR=1.31,95%CI:0.50~3.45,P=0.58)、术后脱位发生率(OR=0.34,95%CI:0.09~1.28],P=0.11)、异位骨化发生率(OR=1.01,95%CI:0.26~3.94,P=0.99)、腹股沟区疼痛发生率(OR=2.73,95%CI:0.62~12.06],P=0.19)均无统计学差异。而且两组的手术时间(WMD=10.25,95%CI:-6.33~26.83],P=0.23)、住院时间(WMD=-0.34,95%CI:-0.76~0.07],P=0.10)、Lewinnek安全区内髋臼假体的数量(OR=2.08,95%CI:0.65~6.72,P=0.22)也无统计学差异。同时,DAA具有预防术后脱位的潜在优势,DAA术中使用X线透视会避免出现明显异常的髋臼假体位置。结论:在熟练掌握DAA THA技术的前提下,DAA是具有一定优势的手术入路。
