[1]文祖洲 陈洪强 吴西智 罗昂 周华 乔俊钊 叶赟**.Bikini切口直接前入路人工全髋关节置换术的学习曲线分析[J].中国微创外科杂志,2024,01(9):604-609.
　Wen Zuzhou,Chen Hongqiang,Wu Xizhi,et al.Analysis of Learning Curve of Bikini Incision Direct Anterior Approach Total Hip Arthroplasty[J].Chinese Journal of Minimally Invasive Surgery,2024,01(9):604-609.
点击复制

Bikini切口直接前入路人工全髋关节置换术的学习曲线分析()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2024年9期
页码:
604-609
栏目:
临床研究
出版日期:
2024-09-25

文章信息/Info

Title:
Analysis of Learning Curve of Bikini Incision Direct Anterior Approach Total Hip Arthroplasty
作者:
文祖洲 陈洪强 吴西智 罗昂 周华 乔俊钊 叶赟**
(贵阳市第四人民医院关节外科，贵阳550002)
Author(s):
Wen Zuzhou;  Chen Hongqiang;  Wu Xizhi;  et al.
Joint Surgery Department, Fourth People’s Hospital of Guiyang, Guiyang 550002, China
关键词:
Bikini切口入路; 全髋关节置换; 学习曲线
Keywords:
Bikini incision approach; Total hip arthroplasty; Learning curve
文献标志码:
A
摘要:
目的探讨Bikini切口直接前入路人工全髋关节置换术(Bikini incision direct anterior approach total hip arthroplasty，BikiniTHA)的学习曲线。方法回顾性分析2020年3月~2023年3月一位熟练掌握后外侧入路和传统直接前入路THA的术者最初完成的80例BikiniTHA的临床资料，通过手术时间和出血量的散点图观察学习曲线。按手术先后顺序分为A~D组，每组20例。比较4组手术时间、术中出血量、髋臼杯外展角、前倾角、股骨柄-髓腔轴线夹角、术后髋关节Harris评分及并发症。结果约40例之后手术时间和术中出血量下降趋势放缓并趋于平稳。4组手术时间和出血量均A组>B组>C、D组(P<0.05)，C组和D组差异无统计学意义(P>0.05)。4组均髋臼假体位置良好(外展角30°~50°，前倾角5°~25°)；股骨假体中心固定率(股骨柄-髓腔轴线夹角≤3°)A组0.05)，术后12个月疗效评价均为优。A组并发症5例(大转子骨折2例，股外侧皮神经损伤3例)，B组并发症3例(大转子骨折1例，股外侧皮神经损伤1例，切口感染1例)，C组并发症1例(股外侧皮神经损伤)，D组无并发症发生。随访12~26个月，(19.4±4.7)月，均无假体脱位、松动等并发症发生。结论BikiniTHA学习曲线大约为40例。/html>
Abstract:
ObjectiveTo explore the learning curve of Bikini incision direct anterior approach total hip arthroplasty (BikiniTHA).MethodsClinical data of 80 cases of BikiniTHA initially completed by an operator skilled in posterolateral approach and direct anterior approach total hip arthroplasty from March 2020 to March 2023 were retrospectively analyzed, and the learning curve was observed by scatter plots of operative time and intraoperative bleeding. They were divided into groups A to D according to the order of surgery, with 20 cases in each group. The operative time, intraoperative bleeding, acetabular abduction angle, anteversion angle, angle between stem and femoral axis, postoperative hip Harris score and complications were compared among the 4 groups.ResultsAfter about 40 cases, the decreasing trend of operative time and intraoperative bleeding slowed down and stabilized. The operative time and intraoperative bleeding in the 4 groups were group A>group B>groups C and D (P<0.05), and the differences between the group C and group D were not statistically significant (P>0.05). The acetabular prosthesis was wellpositioned in the 4 groups (abduction angle of 30°-50°, anteversion angle of 5°-25°). The femoral prosthesis center fixation rate (angle between stem and femoral axis ≤3°) was group A < groups C and D (P=0.003, 0.003). The differences in the Harris scores of the hip joints at 2 weeks, 1 month, 3 months, and 12 months postoperatively of the 4 groups were not statistically significant (P>0.05), and the efficacy evaluations of the hip joints at 12 months postoperatively were all excellent. There were 5 cases of complications in the group A (2 cases of greater trochanter fracture and 3 cases of lateral femoral cutaneous nerve injury), 3 cases of complications in the group B (1 case of greater trochanteric fracture, 1 case of lateral femoral cutaneous nerve injury, and 1 case of incision infection), 1 case of complications in the group C (lateral femoral cutaneous nerve injury), and no complications in the group D. The followup period lasted for 12-26 months, with a mean of (19.4±4.7) months. There were no complications such as dislocation or loosening of the prosthesis.ConclusionThe BikiniTHA learning curve was approximately 40 cases.

参考文献/References:

[1]Aggarwal VK,Elbuluk A,Dundon J,et al.Surgical approach significantly affects the complication rates associated with total hip arthroplasty.Bone Joint J,2019,101-B(6):646-651.
[2]van der Weegen W,Kornuijt A,Das D,et al.It is safe to use minimal restrictions following posterior approach total hip arthroplasty:results from a large cohort study.Hip Int,2019,29(6):572-577.
[3]Wang Q,Yue Y,Yang Z,et al.Comparison of postoperative outcomes between traditional longitudinal incision and bikini incision in total hip arthroplasty via direct anterior approach:a randomized controlled trial.J Arthroplasty,2021,36(1):222-230.
[4]Leunig M,Faas M,von Knoch F,et al.Skin crease ‘bikini’ incision for anterior approach total hip arthroplasty:surgical technique and preliminary results.Clin Orthop Relat Res,2013,471(7):2245-2252.
[5]Lewinnek GE,Lewis JL,Tarr R,et al.Dislocations after total hipreplacement arthroplasties.J Bone Joint Surg Am,1978,60(2):217-220.
[6]Nakata K,Nishikawa M,Yamamoto K,et al.A clinical comparative study of the direct anterior with miniposterior approach:two consecutive series.J Arthroplasty,2009,24(5):698-704.
[7]Harris WH.Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty.An endresult study using a new method of result evaluation.J Bone Joint Surg Am,1969,51(4):737755.
[8]甘锋平,江建中.微创全髋关节置换术手术入路的现状. 中国微创外科杂志,2022,22(1):79-84.
[9]Ramadanov N,Ostojic M,Lazaru P,et al.Risk factors and predictors for functional outcome and complication rate in total hip arthroplasty through minimally invasive and conventional approaches:a systematic review and metaregression analysis of 41 randomized controlled trials.J Clin Med,2023,12(18):5895.
[10]Howell JR,Garbuz DS,Duncan CP.Minimally invasive hip replacement:rationale,applied anatomy,and instrumentation.Orthop Clin North Am,2004,35(2):107-118.
[11]Zawadsky MW,Paulus MC,Murray PJ,et al.Early outcome comparison between the direct anterior approach and the miniincision posterior approach for primary total hip arthroplasty:150 consecutive cases.J Arthroplasty,2014,29(6):1256-1260.
[12]Barrett WP,Turner SE,Murphy JA,et al.Prospective,randomized study of direct anterior approach vs posterolateral approach total hip arthroplasty:a concise 5year followup evaluation.J Arthroplasty,2019,34(6):1139-1142.
[13]Zhou Z,Li Y,Peng Y,et al.Clinical efficacy of direct anterior approach vs. other surgical approaches for total hip arthroplasty:a systematic review and metaanalysis based on RCTs.Front Surg,2022,9:1022937.
[14]Zhao HY,Kang PD,Xia YY,et al.Comparison of early functional recovery after total hip arthroplasty using a direct anterior or posterolateral approach:a randomized controlled trial.J Arthroplasty,2017,32(11):3421-3428.
[15]Haynes JA,Hopper RH Jr,Ho H,et al.Direct anterior approach for primary total hip arthroplasty lowers the risk of dislocation compared to the posterior approach: a single institution experience.J Arthroplasty,2022,37(3):495-500.
[16]Jin X,Chen G,Chen M,et al.Comparison of postoperative outcomes between bikiniincision via direct anterior approach and posterolateral approach in simultaneous bilateral total hip arthroplasty:a randomized controlled trial.Sci Rep,2023,13(1):7023.
[17]张雨,王斌,秦江辉,等.Bikini切口直接前入路全髋关节置换术的短期疗效.中华骨科杂志,2020,40(17):1175-1181.
[18]Corten K,Holzapfel BM.Direct anterior approach for total hip arthroplasty using the “bikini incision”.Oper Orthop Traumatol,2021,33(4):318-330.
[19]Goytia RN,Jones LC,Hungerford MW.Learning curve for the anterior approach total hip arthroplasty.J Surg Orthop Adv,2012,21(2):78-83.
[20]李骏然,翟婧秀,赵洪波,等.牵引床直接前侧入路人工全髋关节置换术的学习曲线分析.中国微创外科杂志,2021,21(11):1024-1030.
[21]Rueckl K,Springer B,JungwirthWeinberger A,et al.A standardized soft tissue release technique to lower the risk of greater trochanteric fractures for the anterior approach in total hip arthroplasty.Arch Orthop Trauma Surg,2022,142(11):3067-3073.

备注/Memo

备注/Memo:
基金项目：贵州省卫生健康委科学技术基金项目(gzwkj2024-031)**通讯作者，Email：yeyun1116@163.com
更新日期/Last Update: 2024-12-17