全髖關節置換術前路入路發生重大併發症的風險高於側入路和後路入路
作者：
小柯機器人發布時間：2020/3/23 21:38:38
全髖關節置換手術入路與重大併發症的關係，這一成果由加拿大多倫多大學Bheeshma Ravi研究組經過不懈努力而取得。相關論文於2020年3月17日發表在《美國醫學會雜誌》上。
關於全髖關節置換術（THA）的首選手術方法存在爭議。
為了確定前路入路是??否比側入路或後路入路的併發症風險更低，2015年4月1日至2018年3月31日，研究組對加拿大安大略省因骨關節炎而接受初次THA治療的成年患者進行了一項基於人群的回顧性隊列研究。所有患者均接受了為期1年的隨訪。
在73家醫院中接受THA的30098例患者的平均年齡為67歲，53.4%為女性。2995例（10%）接受了前路入路； 21248例（70%）接受了側入路；5855例（20％）接受了後路入路。
隨訪1年後，與採用側入或後路入路的患者相比，採用前路入路的患者年齡更小，病態肥胖、糖尿病和高血壓的發生率較低，並由更多的外科醫生進行治療。與進行側入路或後路入路的2993位傾向評分匹配的患者相比，經前路入路的2993位匹配患者發生重大手術併發症的風險明顯更高（分別為2%和1%）。
總之，對於接受THA的患者，前路入路與側入和後路入路手術方法相比，發生重大手術併發症的風險顯著增加。
附：英文原文
Title: Association Between Surgical Approach and Major Surgical Complications in Patients Undergoing Total Hip Arthroplasty
Author: Daniel Pincus, Richard Jenkinson, Michael Paterson, Timothy Leroux, Bheeshma Ravi
Issue&Volume: 2020/03/17
Abstract: Importance Controversy exists about the preferred surgical approach for total hip arthroplasty (THA).Objective To determine whether an anterior approach is associated with lower risk of complications than either a lateral or posterior approach.Design, Setting, and Participants Population-based retrospective cohort study of all adults in Ontario, Canada, who had undergone primary THA for osteoarthritis between April 1, 2015, and March 31, 2018. All patients were followed up over a 1-year period (study end date, March 31, 2019).Exposures Surgical approach (anterior vs lateral/posterior) for THA.Main Outcomes and Measures Major surgical complications within 1 year (composite of deep infection requiring surgery, dislocation requiring closed or open reduction, or revision surgery). Outcomes were compared among propensity-score matched groups using Cox proportional hazards regression.Results Of the 30098 patients (mean [SD] age, 67 years [10.7 years]; 16079 women [53.4%]) who underwent THA, 2995 (10%) underwent the anterior approach; 21248 (70%), the lateral approach; and 5855 (20%) the posterior approach performed at 1 of 73 hospitals by 1 of 298 surgeons. All patients were followed up for 1 year. Compared with those undergoing the lateral or posterior approach, patients undergoing an anterior approach were younger (mean age, 65 vs 67 years; standardized difference, 0.17); had lower rates of morbid obesity (4.8% vs 7.6%; standardized difference, 0.12), diabetes (14.2% vs 19.9%; standardized difference, 0.15), and hypertension (53.4% vs 62.9%; standardized difference, 0.19); and were treated by higher-volume surgeons (median range, 111 procedures; interquartile range, 69-172 vs 77 procedures, interquartile range, 50-119 in the prior year; standardized difference, 0.55). Compared with 2993 propensity-score matched patients undergoing a lateral or posterior approach, the 2993 matched patients undergoing anterior approaches had a significantly greater risk of a major surgical complication (61 patients [2%] vs 29 patients [1%]; absolute risk difference, 1.07%; 95% CI, 0.46%-1.69%; hazard ratio, 2.07; 95% CI, 1.48 to 2.88).Conclusions and Relevance Among patients undergoing total hip arthroplasty, an anterior surgical approach compared with a posterior or lateral surgical approach was associated with a small but statistically significant increased risk of major surgical complications. The findings may help inform decisions about surgical approach for hip arthroplasty, although further research is needed to understand pain and functional outcomes.
DOI: 10.1001/jama.2020.0785
Source: https://jamanetwork.com/journals/jama/article-abstract/2762906