BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications o...BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,wound complication,and nerve injury)found DAA was the best approach followed by DSA/SuperPath.CONCLUSION DSA/SuperPath had better earlier functional outcome than PA,but still could not overcome the result of DAA.This technique might be the other preferred option with acceptable complications.展开更多
目的:探讨经皮辅助关节囊微创(supercapsalar percutaneously assisted total hip,SuperPATH)入路全髋关节置换术(total hip arthroplasty,THA)的临床疗效、学习曲线。方法:选择102例髋关节疾病患者采用SuperPATH-THA治疗,记录手术情况...目的:探讨经皮辅助关节囊微创(supercapsalar percutaneously assisted total hip,SuperPATH)入路全髋关节置换术(total hip arthroplasty,THA)的临床疗效、学习曲线。方法:选择102例髋关节疾病患者采用SuperPATH-THA治疗,记录手术情况、术后并发症、臼杯外展角和前倾角、术后24 h疼痛视觉模拟量表(visual analogue scale,VAS)评分及术后第7天Harris髋关节功能评分,通过分析前后手术病例的相关指标,评价该术式的学习曲线。结果:患者均获得随访,时间6~25个月,手术时间、术中出血量、住院时间在完成36例SuperPATH-THA后明显下降,趋于稳定。以36例为界,分为学习期(36髋)和稳定期(66髋)。SuperPATH-THA稳定期的手术时间、术中出血量、首次下地时间、住院时间明显小于学习期,差异有统计学意义(P均<0.01)。SuperPATH-THA学习期与稳定期在手术切口长度、臼杯外展角和前倾角、术后24 h VAS评分及术后第7天髋关节功能Harris评分方面的差异均无统计学意义(P>0.05)。学习期内发生假体脱位1例,假体周围骨折1例。结论:SuperPATH-THA具有符合微创和快速康复理念、住院时间短、并发症发生率低等优势;SuperPATH-THA学习曲线为36例左右,度过学习曲线后,能为患者提供更好的手术疗效。展开更多
本期刊登朱成栋等医师＂Super PATH入路微创全髋关节置换14例早期随访报告＂一文,又唤起我对微创全髋关节置换（total hip arthroplasty,THA）初期的回忆。20世纪末,一些成熟的关节外科医师对经典THA入路,诸如大转子截骨外侧入路,Smith ...本期刊登朱成栋等医师＂Super PATH入路微创全髋关节置换14例早期随访报告＂一文,又唤起我对微创全髋关节置换（total hip arthroplasty,THA）初期的回忆。20世纪末,一些成熟的关节外科医师对经典THA入路,诸如大转子截骨外侧入路,Smith Petesen前入路以及需20 cm长且包括广泛松解臀大肌止点在内的后外侧入路产生质疑。经专家和器械厂商的共同努力,设计并生产了一些特殊手术器械,如各型牵开器,展开更多
文摘BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,wound complication,and nerve injury)found DAA was the best approach followed by DSA/SuperPath.CONCLUSION DSA/SuperPath had better earlier functional outcome than PA,but still could not overcome the result of DAA.This technique might be the other preferred option with acceptable complications.
文摘目的:探讨经皮辅助关节囊微创(supercapsalar percutaneously assisted total hip,SuperPATH)入路全髋关节置换术(total hip arthroplasty,THA)的临床疗效、学习曲线。方法:选择102例髋关节疾病患者采用SuperPATH-THA治疗,记录手术情况、术后并发症、臼杯外展角和前倾角、术后24 h疼痛视觉模拟量表(visual analogue scale,VAS)评分及术后第7天Harris髋关节功能评分,通过分析前后手术病例的相关指标,评价该术式的学习曲线。结果:患者均获得随访,时间6~25个月,手术时间、术中出血量、住院时间在完成36例SuperPATH-THA后明显下降,趋于稳定。以36例为界,分为学习期(36髋)和稳定期(66髋)。SuperPATH-THA稳定期的手术时间、术中出血量、首次下地时间、住院时间明显小于学习期,差异有统计学意义(P均<0.01)。SuperPATH-THA学习期与稳定期在手术切口长度、臼杯外展角和前倾角、术后24 h VAS评分及术后第7天髋关节功能Harris评分方面的差异均无统计学意义(P>0.05)。学习期内发生假体脱位1例,假体周围骨折1例。结论:SuperPATH-THA具有符合微创和快速康复理念、住院时间短、并发症发生率低等优势;SuperPATH-THA学习曲线为36例左右,度过学习曲线后,能为患者提供更好的手术疗效。
