全髋关节置换术中手术入路的临床疗效和安全性比较

Q3 Medicine Genij Ortopedii Pub Date : 2023-08-31 DOI:10.18019/1028-4427-2023-29-4-438-448
© Ерёмин, Иван Константинович Ерёмин, Армен Альбертович,  Данильянц2, Николай Васильевич Загородний, Ivan K. Eremin, Armen A. Daniliyants, N. V. Zagorodniy
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引用次数: 0

摘要

背景:晚期关节关节病是患者致残的主要原因。全髋关节置换术被认为是治疗不能接受保守治疗的髋关节病变的“金标准”。关节置换术被引入临床实践,显著改善了患者的功能状况。这些数据在很大程度上是相互矛盾的,并表明在手术后患者的治疗和康复阶段存在一定的困难和风险。根据大规模比较研究的结果,探索不同方法在关节成形术患者各阶段治疗的有效性,通过改进患者队列的治疗方法,可以克服这些缺点。目的是在全髋关节置换术(THA)的临床疗效和安全性方面寻找最合理和最有前途的手术方法。材料和方法使用Scopus, PubMed和电子科学图书馆eLIBRARY的俄语和英语数据库进行出版物搜索,关键词为:全髋关节置换术,微创入路,THA前外侧入路,THA直接外侧入路,THA后路入路,髋关节置换术入路的比较评估,先进的置换技术,THA术后并发症发生率,THA直接前路入路。结果和讨论许多研究表明,采用直接前路通路(DAA)的干预措施具有出血量少、输血次数少、手术时间短和住院时间短的特点。术后早期髋关节功能恢复较快,对阿片类镇痛药的需求较少。DAA组并发症发生率高于对照组,与学习曲线直接相关。结论DAA是一种先进的手术方法,在外科医生经验丰富的情况下,可以提高大多数髋关节病患者的临床疗效和手术治疗的安全性。该方法可以认为是低创伤性的。与其他方法不同,DAA对完整组织的损伤较小;皮肤切口较小;失血少;术后沉淀康复;术后疼痛程度较轻,较少需要阿片类镇痛。然而,在主要复杂的髋关节病变中,DAA不如经典入路。
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Comparative evaluation of the clinical efffcacy and safety of surgical approaches in total hip arthroplasty
Background Advanced coxarthrosis is a leading cause of disability in patients. Total arthroplasty is regarded as the "gold standard" for the treatment of hip pathologies that are not amenable to conservative treatment. Arthroplasty introduced into clinical practice has significantly improved functional status of patients. The data are largely contradictory and indicate certain difficulties and risks at the stages of treatment and rehabilitation of patients after surgery. The shortcomings can be overcome by improving the treatment methods for the cohort of patients based on the results of large-scale comparative studies exploring the effectiveness of different approaches to all stages of treatment of arthroplastic patients.The objective was to search for the most justified and promising surgical approaches in terms of clinical efficacy and safety of total hip arthroplasty (THA).Material and methods The search for publications was produced using the databases of Scopus, PubMed and the electronic scientific library eLIBRARY in Russian and English languages using the keywords: total hip arthroplasty, minimally invasive approach, anterolateral approach in THA, direct lateral approach in THA, posterior approach in THA, comparative assessment of approaches in hip arthroplasty, advanced replacement techniques, incidence of postoperative complications in THA, direct anterior approach in THA.Results and discussion A number of studies have shown that interventions using direct anterior access (DAA) are characterized by less blood loss, less frequent blood transfusions, less operating time and shorter hospital stay. There was a more rapid recovery of the hip function during early postoperative period with less need for opioid analgesics with DAA. Complication rate was higher with DAA than in the comparison group, which directly correlated with the learning curve.Conclusion DAA was shown to be an advanced approach that resulted in enhanced clinical efficacy and safety of surgical treatment in the majority of patients with coxarthrosis with sufficient experience of the surgeon. The method can be considered as low-traumatic. Unlike other approaches, DAA was accompanied by less injury to intact tissues; smaller skin incision; less blood loss; precipitated postoperative rehabilitation; less severity of postoperative pain and less need for opioid analgesia. However, DAA is inferior to classical approaches in primarily complicated hip pathologies.
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来源期刊
Genij Ortopedii
Genij Ortopedii Medicine-Surgery
CiteScore
0.70
自引率
0.00%
发文量
104
审稿时长
12 weeks
期刊介绍: Journal’s main goal is to contribute to the development of the contemporary medical science via presentation of fundamental and applied original scientific studies to the scientific and practical medical community that would widen and deepen the understanding of the most important problems in the field of traumatology, orthopaedics, and related specialties. Our journal provides a direct open access to its content which is based on the principle that the open access option promotes global exchange of knowledge and experience. Journal’s strategy: -Development of the journal as a scientific platform for researchers, doctors, post-graduates and residents -Attraction of highly-cited authors to publish their studies -Selection of manuscripts of scientific interest for readers that will impact on journal citation index in RINC -Increase in the portion of publications submitted by foreign authors and studies conducted in association with foreign scientists; growth of citations in the journals that are included into global systems of indexing and reputable databases -Improvement of the Journal’s web site in two languages for a greater accessibility by authors and readers -Introduction of the Journal into global indexing systems
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