Comparison of gait and hip ambulation ability after total hip arthroplasty through different approaches / 中国组织工程研究

BACKGROUND:In the selection of minimally invasive total hip arthroplasty approaches,there is considerable debate about whether direct anterior and posterior approaches differ in postoperative gait,limb balance,and hip motor capacity,and therefore further investigation is warranted. OBJECTIVE:To assess the gait and hip ambulation ability of direct anterior and posterior approaches for primary unilateral total hip arthroplasty with a prospective randomized controlled study. METHODS:A total of 61 patients with unilateral avascular necrosis of the femoral head in Qingdao Municipal Hospital from January 2019 to June 2020 were included in the study.There were 40 males and 21 females,at a mean age of(64.83±5.52)years.All the patients were randomly divided into a direct anterior approach group(n=28)and a posterior approach group(n=33),and received initial total hip arthroplasty by direct anterior approach and posterior approach,respectively.Gait analysis(gait time-space parameters such as stride length,stride frequency,single-leg support time,and plantar pressure difference)and hip ambulation ability(standing-walking timing test and 2-minute walking test)were performed before and 1,3 and 6 months after operation. RESULTS AND CONCLUSION:(1)With the extension of postoperative time,gait time-space parameters in both groups were gradually improved.The stride length,stride frequency,single-leg support time,and plantar pressure difference in the direct anterior approach group were significantly better than those in the posterior approach group 1 month after surgery(P<0.01).The stride frequency,single-leg support time,and plantar pressure difference in the direct anterior approach group were significantly better than those in the posterior approach group 3 months after surgery(P<0.05).The plantar pressure difference in the direct anterior approach group was significantly better than that in the posterior approach group 6 months after surgery(P<0.01).(2)With the extension of postoperative time,the results of the standing-walking timing test and 2-minute walking test were gradually improved in both groups.The results of the standing-walking timing test and 2-minute walking test 1 and 3 months after operation in the direct anterior approach group were better than those in the posterior approach group(P<0.05).(3)The results have indicated that the recovery of postoperative gait and hip ambulation ability of the two groups is inconsistent.The direct anterior approach group has some advantages in the improvement of postoperative gait and hip ambulation ability compared with the posterior approach group in the early postoperative period.

Mid-and long-term state after total hip arthroplasty versus hemiarthroplasty for femoral neck fractures in the elderly:evaluation using propensity score matching method / 中国组织工程研究

BACKGROUND:Arthroplasty is the primary treatment for displaced femoral neck fractures in the elderly,and the choice of total hip arthroplasty versus hemiarthroplasty is currently the subject of considerable debate. OBJECTIVE:To compare the mid-and long-term survival status of total hip arthroplasty versus hemiarthroplasty under a direct anterior approach for displaced femoral neck fractures in the elderly based on the propensity score matching method. METHODS:One hundred and forty-seven elderly patients(≥65 years of age)with displaced femoral neck fractures were admitted from January 2016 to January 2021,of whom 88 had total hip arthroplasty(total hip arthroplasty group)and 59 had artificial femoral head replacement(hemiarthroplasty group).For the patients'preoperative comorbidities,the age-corrected Charlson Comorbidity Scale was used to quantify the scores and calculate patient frailty.The propensity score matching method was used to match the two groups 1:1 and to compare the operation time,bleeding,postoperative hospitalization time,hospitalization cost,nutritional index,postoperative complications,and mortality between the two groups after matching.Postoperative survival time was determined by Kaplan-Meier Survival analysis. RESULTS AND CONCLUSION:(1)After propensity score matching,a total of 42 matched pairs were successful in both groups,and the preoperative data of patients in both groups were balanced and comparable after matching(P>0.05).(2)Compared with the hemiarthroplasty group,operation time(79.71 minutes vs.59.07 minutes,P<0.001),bleeding volume(839.64 mL vs.597.83 mL,P=0.001),and hospitalization cost(56 508.15 yuan vs.41 702.85 yuan,P<0.001)were significantly higher in the total hip arthroplasty group.However,the mortality rate was lower in the total hip arthroplasty group than in the hemiarthroplasty group(36%vs.57%,HR=0.44,95%CI:0.23-0.87,P=0.018),and the mean survival time was longer in the total hip arthroplasty group than in the hemiarthroplasty group(59.4 months vs.43.7 months,P=0.024).(3)There were no statistically significant differences in postoperative hospitalization time,preoperative and postoperative nutritional indicators,and overall postoperative complication rate between the two groups(P>0.05).However,in terms of postoperative pain,the incidence of pain was significantly higher in the hemiarthroplasty group than that in the total hip arthroplasty group(24%vs.7%,P=0.035).(4)Overall,total hip arthroplasty has a better prognosis for survival,while hemiarthroplasty is more appropriate for patients with poor physical fitness.At the same time,postoperative pain may largely affect the quality and survival time of patients after hip arthroplasty.

Clinical study of posterior to anterior approach with posteromedial vertical syndesmotic line in treatment of posterior malleolus fractures / 局解手术学杂志

Objective To explore the clinical effect of closed reduction and internal fixation with percutaneous cannulated screws through posterior to anterior(PA)approach with reference to posteromedial vertical syndesmotic line(PVSL)for the treatment of posterior malleolus fractures.Methods A total of 23 patients with posterior malleolus fractures in our hospital from January 2020 to January 2022 were slected,and received closed reduction and internal fixation with percutaneous cannulated screws through PA approach with reference to PVSL.The fracture reduction,functional recovery of ankle joint,occurrence of complications,and rehabilitation of patients after surgery were recorded.Results After surgery,23 patients were followed up for 6 to 20 months.After surgery,the posterior malleolar fracture fragments of all patients were of good reduction,with the displacement less than 2 mm.The X-ray showed that all fractures healed,with the fracture healing time of 3 to 6 months.The American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scores ranged from 76 to 100 points,with an average of(89.8±8.2)points;the ankle joint function was excellent in 17 cases,good in 5 cases,and moderate in 1 case,with an excellent and good rate of 95.7%.No complications such as screw loosening or breakage occurred in all cases.Conclusion The closed reduction and internal fixation with percutaneous cannulated screws through PA approach with reference to PVSL has a significant surgical effect for posterior malleolus fractures,which is worthy of clinical promotion and application.

Angle Evaluation of Possible Routes that Can Be Used to Reach the Foramen Ovale in the Anterior Approach / Evaluación Angular de Posibles Rutas que se Pueden Utilizar para Alcanzar el Foramen Oval en el Abordaje Anterior

SUMMARY: For the treatment of trigeminal neuralgia, the foramen ovale is reached by entering the cheek with a needle. Thermocoagulation is performed with balloon compression, administration of alcohol or radiofrequency. Apart from the classical method, it is theoretically possible to reach the foramen ovale through the mouth with the anterior approach. In our study, it was aimed to examine horizontally and vertically the angular values that must be given to the needle to reach the foramen ovale in the anterior approach. Three landmark points were determined on both right and left sides of 25 dry skulls. A rod was inserted starting from these landmark points and passing through the center of the foramen ovale. The vertical and horizontal angular values of this bar were measured. For each foramen ovale, 3 vertical angles, 3 horizontal angles and 4 distance measurements were made. There was a significant difference between the right and left sides in terms of horizontal angular values. Average values of horizontal angles (in degrees); on the right, 7.29 for H1, 12.15 for H2, 32.29 for H3; 1.26 for H1, 9.46 for H2, and 30.56 for H3 on the left side (p<0.005). The angle value was measured as 0 or negative value in 5 (20 %) of the H1 angle measurements made on the right side and 14 (56 %) on the left side. The H2 angle value was found to be smaller than the H1 angle in the skull 2 (8 %) on the right and 3 (12 %) on the left. There was no difference between the right and left sides in terms of vertical angular values. A significant difference was found between the right and left sides in the D1, D2, D4 distances (p<0.005). Six important anatomical features affecting angular values were encountered.

Para el tratamiento de la neuralgia del trigémino, se alcanza el foramen oval introduciendo una aguja en la mejilla. La termocoagulación se realiza con compresión con balón, administración de alcohol o radiofrecuencia. Aparte del método clásico, en teoría es posible alcanzar el foramen oval a través de la cavidad oral mediante el abordaje anterior. En nuestro estudio se tuvo como objetivo examinar horizontal y verticalmente los valores angulares que se deben dar a la aguja para alcanzar el foramen oval en el abordaje anterior. Se determinaron tres puntos de referencia en los lados derecho e izquierdo de 25 cráneos secos. Se insertó una varilla comenzando desde estos puntos de referencia y pasando por el centro del foramen oval. Se midieron los valores angulares verticales y horizontales de esta barra. Para cada foramen oval se realizaron mediciones de 3 ángulos verticales, 3 ángulos horizontales y 4 distancias. Hubo una diferencia significativa entre los lados derecho e izquierdo en términos de valores angulares horizontales. Valores medios de ángulos horizontales (en grados); a la derecha, 7,29 para H1, 12,15 para H2, 32,29 para H3; 1,26 para H1, 9,46 para H2 y 30,56 para H3 en el lado izquierdo (p<0,005). El valor del ángulo se midió como 0 o valor negativo en 5 (20 %) de las mediciones del ángulo H1 realizadas en el lado derecho y 14 (56 %) en el lado izquierdo. Se encontró que el valor del ángulo H2 era menor que el ángulo H1 en el cráneo 2 (8 %) a la derecha y 3 (12 %) a la izquierda. No hubo diferencia entre los lados derecho e izquierdo en términos de valores angulares verticales. Se encontró diferencia significativa entre el lado derecho e izquierdo en las distancias D1, D2, D4 (p<0,005). Se encontraron seis características anatómicas importantes que afectan los valores angulares.

Direct anterior approach complications for total hip arthroplasty / Complicaciones del abordaje anterior directo en artroplastía total de cadera

Abstract: The direct anterior approach (DAA) for total hip arthroplasty has been popularized in the last decade as a minimally invasive approach used by many surgeons, including the authors, to preserve the integrity of muscle groups and their insertions and the dynamic hip stability resulting in less surgical trauma and faster recovery process with decreased postoperative pain. This surgical approach is not without a variety of complications and pitfalls. This review aims to identify any potential drawbacks and challenges associated with the DAA in THA and guide surgeons on minimizing and avoiding them.

Resumen: El abordaje anterior directo (AAD) en artroplastía total de cadera se ha popularizado en la última década como un abordaje de mínima invasión utilizado por varios cirujanos, incluyendo a los autores, con la ventaja de preservar la integridad de los grupos musculares de la cadera y sus inserciones, así como la estabilidad dinámica de la articulación, resultando en menor trauma quirúrgico y una recuperación más rápida con menos dolor postoperatorio, a pesar de esto, el abordaje quirúrgico no está exento de complicaciones. El propósito de esta revisión es describir los riesgos y complicaciones potenciales relacionados al abordaje anterior directo en cirugía de artroplastía total de cadera y presentar una guía de cómo minimizarlas o evitarlas.

Artroplastia total de cadera en dos instituciones ortopédicas de Cuba / Total hip arthroplasty in two orthopedic institutions in Cuba

Introducción: La artroplastia total de cadera se considera un procedimiento seguro y eficaz que alivia el dolor, y mejora la salud física y la calidad de vida en los pacientes. Objetivos: Caracterizar la artroplastia total de cadera en pacientes intervenidos en el Hospital Ortopédico Docente Fructuoso Rodríguez y el Complejo Científico Ortopédico Frank País. Métodos: Estudio descriptivo retrospectivo de pacientes intervenidos con artroplastia total de cadera en el Hospital Ortopédico Docente Fructuoso Rodríguez y el Complejo Científico Ortopédico Frank País, entre septiembre de 2019 y marzo de 2021. Resultados: Predominaron el sexo femenino y las edades entre 60 y 62 años, con lateralidad izquierda. El principal diagnóstico preoperatorio resultó la coxartrosis. El tamaño de la copa acetabular y la cabeza del componente femoral fueron similares. La prótesis acetabular se fijó por presión. Conclusiones: Se encontraron grandes semejanzas en cuanto a la edad, el sexo, la lateralidad, el tamaño de los componentes acetabular y cabeza femoral, el tipo de fijación del componente acetabular y la cantidad de tornillos empleados. En el diagnóstico preoperatorio prevaleció la artrosis de cadera(AU)

Introduction: Total hip arthroplasty is considered a safe and effective procedure that relieves pain and improves physical health and quality of life in patients. Objectives: To characterize the patients who underwent total hip arthroplasty at Fructuoso Rodríguez Teaching Orthopedic Hospital and Frank País Orthopedic Scientific Complex. Methods: A retrospective descriptive study was conducted with patients who underwent total hip arthroplasty at Fructuoso Rodríguez Teaching Orthopedic Hospital and Frank País Orthopedic Scientific Complex, from September 2019 to March 2021. Results: The female sex and the ages between 60 and 62 years predominated, with left laterality. The main preoperative diagnosis was coxarthrosis. The size of the acetabular cup and the head of the femoral component were similar. The acetabular prosthesis was fixed by pressure. Conclusions: Great similarities were found in terms of age, sex, laterality, the size of the acetabular components and femoral head, the type of fixation of the acetabular component and the number of screws used. Osteoarthritis of the hip prevailed In the preoperative diagnosis(AU)

Artroplastia total de cadera por abordaje anterior directo (Hueter) / Total hip arthroplasty by direct anterior approach (Hueter)

Introducción: La artroplastia de cadera se considera un tratamiento exitoso en ortopedia. El abordaje anterior directo, a través del intervalo de Hueter, evita la disección de inserciones musculares del hueso y disminuye la alteración de los tejidos blandos alrededor de la cadera. Objetivos: Presentar los resultados de artroplastias totales de cadera primarias, realizadas por abordaje anterior directo. Métodos: Se realizó un estudio descriptivo-prospectivo, tipo serie de casos, con pacientes intervenidos por artroplastia total de cadera primaria no cementada a través de abordaje anterior directo. Resultados: Predominaron el sexo femenino y los grupos etarios de 45 y 60 años. El índice de masa corporal resultó bajo y hubo escaso riesgo anestésico. El tiempo quirúrgico superó las dos horas, con escaso sangrado operatorio. La correcta colocación del componente acetabular y el femoral permitió que la deambulación iniciara en menos de tres días. Las complicaciones fueron escasas y se resolvieron con el tratamiento adecuado. Conclusiones: El empleo de abordaje anterior directo para artroplastias totales de cadera primarias ofrece resultados muy satisfactorios(AU)

Introduction: Hip arthroplasty is considered a successful treatment in Orthopedics. The direct anterior approach, through Hueter interval, avoids the dissection of muscular attachments to the bone and decreases the alteration of the soft tissues around the hip. Objectives: To report the results of primary total hip arthroplasties, performed by direct anterior approach. Methods: A descriptive-prospective case series study was carried out with patients who underwent primary uncemented total hip arthroplasty through a direct anterior approach. Results: The female sex and the age groups of 45 and 60 years predominated. The body mass index was low and there was little anesthetic risk. Surgical time exceeded two hours, with little operative bleeding. The correct placement of the acetabular and femoral components allowed ambulation to begin in less than three days. Complications were rare and resolved with appropriate treatment. Conclusions: The use of the direct anterior approach for primary total hip arthroplasties offers very satisfactory results(AU)

Effect of posture on total hip arthroplasty through direct anterior approach / 中国骨伤

OBJECTIVE@#To investigate the effect of different postures on direct anterior approach(DAA) total hip arthroplasty.@*METHODS@#Total of 94 patients who underwent DAA total hip arthroplasty from July 2016 to June 2020 were retrospectively analyzed. They were divided into two groups according to different positions during the operation, including 45 cases in lateral position and 49 cases in supine position (with the aid of stent). The general data such as gender, affected limb, body mass index(BMI), incision length, operation time, intraoperative bleeding volume, drainage volume 24 hours after operation, hemoglobin difference before and after operation, first landing time after operation, postoperative hospitalization time, postoperative complications, visual analogue scale(VAS) at 1 day, 1, 2 weeks, 1, 3 and 6 months after operation, Harris score at 1, 2 weeks, 1, 3 and 6 months after operation were observed and compared between the two groups.@*RESULTS@#Patients in both groups were followed up for 6 to 12 months with an average of (8.31±2.22) months. There was no significant difference between two groups in gender, affected limb, age, height, weight, body mass index(BMI), preoperative VAS score and preoperative Harris score(P>0.05). The incision length, operation time, intraoperative bleeding volume, 24-hour drainage volume, hemoglobin difference before and after operation, first time to the ground and postoperative hospitalization time of patients in supine position (assisted by stent) group were all better than those in lateral position group(P<0.05);There was no significant difference in the number of blood transfusions during and after operation(P=0.550). There was no significant difference in anteversion angle and abduction angle in the supine position(with the aid of stent) group during and after operation (P=0.825, P=0.066);There was significant difference in anteversion angle and abduction angle in the lateral position group during and after operation(P<0.05). VAS of patients in supine position (assisted by stent) group were lower than those in lateral position group at 1 day, 1, 2 weeks and 1 month after operation(P<0.05), and there was no statistical difference between two groups at 3 and 6 months after operation(P>0.05). Harris scores of patients in supine position(assisted by stent) group were higher than those in lateral position group at 1 week, 1 month and 3 months after operation(P<0.05), and there was no significant difference between two groups at 6 months after operation(P>0.05).@*CONCLUSION@#Compared with the lateral position, the supine position DAA total hip arthroplasty has the advantages of small incision, short operation time, less bleeding, early landing time, short hospitalization time, and small intraoperative acetabular cup position judgment error. It has the advantage of fast postoperative recovery, but the recovery of hip joint function is the same after 6 months.

Efficacy and safety offemoral head replacement through the direct anterior approach assisting by the traction tablefor femoral neck fracture in the elderly / 实用医学杂志

Objective To analyze the clinical efficacy and safety off emoral head replacement(FHR)assisting by the traction table in direct anterior approach(DAA)for the treatment of femur neck fractures in gerontal patients.Methods A retrospective analysis was conducted on 79 elderly patients who under went FHR for femoral neck fractures from March 2019 to July 2020.A total of 42 patients underwent FHR through DAA by using traction table were assigned to the observation group and 37 patients receiving FHR through the PLA to the control group.The perioperative data,follow-up results and complications were compared between the two groups.Results The observation group was significantly superior to the control group in intraoperative blood loss(P<0.05),where as the former was inferior to the latter in preoperative preparation time(P<0.05).There was no significant difference in anesthesia time and operation time between the two groups(P>0.05).The observation group resumed first postoperative standing time,partial-weight bearing walking time and full-weight bearing walk-ing time significantly earlier than control group(P<0.05).Harris score at 1 month after the operation in the observation group were significantly higher than that of the control group(P<0.05),whereas which became not statistical significant between the two groups in 6 months and 1 year(P>0.05).No significant difference was found between the two groups for the incidence of complications(P>0.05).Conclusion DAA-FHR assisting by the traction table for the treatment of femur neck fractures in the elderly was effective and safe,but the preoperative preparation time was longer.

Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture (version 2023) / 中华创伤杂志

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

Posterior atlantoaxial non-fusion fixation versus anterior cervical odontoid screw fixation in treatment of odontoid fracture of Anderson-D'Alonzo type Ⅱ / 中华创伤骨科杂志

Objective:To compare the curative effects of posterior atlantoaxial non-fusion fixation and anterior cervical odontoid screw fixation in the treatment of odontoid fracture of Anderson-D'Alonzo type Ⅱ.Methods:A retrospective study was conducted to analyze the clinical data of 21 patients with odontoid type II fracture who had been treated at Department of Spine Surgery, The Central Hospital of Luohe from January, 2015 to January, 2020. The patients were divided into a posterior group subjected to posterior atlantoaxial non-fusion fixation and an anterior group subjected to anterior cervical odontoid screw fixation. In the posterior group of 12 patients, there were 7 males and 5 females with an age of (42.2±11.8) years. In the anterior group of 9 patients, there were 5 males and 4 females with an age of (40.0±9.1) years. The 2 groups were compared in terms of operation time, bleeding volume, intraoperative fluoroscopy, fusion time, cervical rotation and neck dysfunction index (NDI).Results:The differences in the preoperative general information were not statistically significant between the 2 groups, indicating comparability ( P>0.05). The implants were successfully inserted in all patients. Intraoperative fracture reduction was satisfactory and no arteriovenous or spinal cord injuries occurred. The mean follow-up time was (24.5±11.3) months. The operation time [(108.5±15.9) min] and bleeding volume [(48.3±12.2) mL] in the anterior group were significantly less than those in the posterior group [(153.9±34.2) min and (275.8±56.0) mL], and the intraoperative fluoroscopy [(13.0±2.1) times] in the anterior group was significantly higher than that in the posterior group [(7.2±1.4) times] ( P<0.05). There was no statistically significant difference in fracture healing time between the 2 groups ( P>0.05). There was no statistically significant difference either in total cervical rotation or NDI between the 2 groups at the last follow-up ( P>0.05). Conclusions:Posterior atlantoaxial non-fusion fixation can preserve the range of rotation of the cervical spine and reduce the dysfunction of the cervical spine. The anterior screw fixation may result in shorter operation time and less intraoperative bleeding, but more intraoperative X-ray fluoroscopy. Therefore, the 2 internal fixation methods should be adopted on the basis of each individual in the treatment of odontoid type Ⅱ fracture to achieve good curative results.

Discussion on the technical points of laparoscopic anterior approach to right hemihepatectomy / 中华肝胆外科杂志

Unlike the traditional surgical approach, which requires priority treatment of the perihepatic ligament and rotation of the liver, the anterior approach to the right hemicolectomy does not deal with the perihepatic ligament prior to parenchymal dissection and rotate and move the liver. The advantage is that it is more in line with the tumor-free principle and reduces unnecessary free. The disadvantage is that it is relatively difficult to control bleeding during the cleavage of the liver and there is some risk in the handling of the lower part of the vena cava sulcus. However, with the popularization and application of laparoscopy, it is more suitable for performing anterior approach right hemicolectomy than open surgery due to its unique caudodorsal view advantage, finer local anatomical structure display and subtle manipulation. This article discusses the procedures and technical points of laparoscopic right hemihepatectomy through the anterior approach.

Comparison of early clinical outcomes between SuperCap and direct anterior approaches for total hip arthroplasty / 中国骨伤

OBJECTIVE@#To compare the short-term clinical efficacy of SuperCap approach and direct anterior approach in total hip arthroplasty.@*METHODS@#Clinical data of 70 patients who underwent minimally invasive SuperCap approach and DAA THA in January 2016 to June 2017 were retrospective analyzed. These patients were divided into two groups:SuperCap approach group(SuperCap group) and direct anterior approach group(DAA group). There were 15 males and 15 females in SuperCap group, aged from 45 to 71 years old, and the follow-up time ranged from 24 to 30 months. There were 24 males and 16 females in Group B, aged from 51 to 76 years and the follow-up time ranged from 24 to 36 months. Hemoglobin level of the 3rd day after operation, transfusion rate, acetabular abduction angle, anteversion angle and creatine kinase level of the 3rd day after operation, Harris score of 3 months and the last time, VAS score of 1 week and the last time were recorded and compared. Complications were recorded at the final follow-up.@*RESULTS@#All patients were followed up, the follow-up time of SuperCap group ranged from 24 to 30 months, that of DAA group ranged from 24 to 36 months. No significant differences were found in hemoglobin level on the 3rd day after operation, transfusion rate, Harris score or VAS score between two group (P>0.05). There was no significant difference in Harris score between 3 months after operation and the final follow-up in both groups (P>0.05). There were no significant difference in VAS scores of 6 weeks after operation and on the final follow-up neither(P>0.05). The level of creatine kinase in SuperCap group was significant lower than that in DAA group(P<0.05). Until the final follow-up, there was no significant difference in the incidence of complications between the two groups(P>0.05).@*CONCLUSION@#The clinical effect of minimally invasive SuperCap approach after total hip arthroplasty is comparable to that of DAA approach with less soft tissue injury. Patients can recover rapidly after operation and it is a safe and effective surgical approach for surgeons with short learning curve.

Comparison of Anterior and Lateral Approach in Hip Hemiarthroplasty for Femur Neck Fractures in the Elderly: Clinical and Radiographic Outcomes

@#Introduction: Many surgical approaches have been described for hip hemiarthroplasty (HHA) treating femur neck fractures (FNFs). Direct lateral approach (DLA) is one of the most used. Today, the direct anterior approach (DAA) has become very attractive, but it seems to involve more intra-operative fractures. Our main endpoint was to demonstrate that the DAA may be a valid alternative comparing to the DLA. Materials and methods: Patients affected by FNFs and treated with HHA between the years 2016 and 2020 were studied. We divided the treatment of the fractures according to the surgical approach. The analysis was focused on perioperative complications and radiological outcomes. Results: There were a total of 166 patients. The DLA group included patients with an average age of 83.5 years and the DAA group of 83 years. We found similar surgical times (DLA 67 min vs DAA 61 min; p = 0,55), number of transfusions (DLA 3/person vs DAA 4/person; p = 0,91), perioperative complications (fractures: DLA 0 vs DAA 0 – dislocations: DLA 2,50% vs DAA 0) and functional outcomes (HHS: DLA 83 points vs DAA 87 points; p = 0,71). There were no statistical differences comparing diaphyseal filling (Canal Fill Index at the proximal third: DLA 0,79 vs DAA 0,78; p= 0,24), bone loss (Paprosky I: DLA 96,25% vs DAA 91,86%; p = 0,47) and prevalence of heterotopic ossification (Broker low degree: DLA 93,75% vs 95, 34%; p = 0,87). Conclusion: Analysing perioperative complications and studying post-operative radiographic evolution, our results suggest that the DAA is a valid alternative to the DLA in HHA treating FNFs.

Clinical analysis of the feasibility and safety of single utility port robot-assisted lung resection / 中国胸心血管外科临床杂志

@#Objective    To investigate the feasibility and safety of single utility port Da Vinci robot-assisted lung resection via anterior approach. Methods    The clinical data of 21 patients who underwent single utility port Da Vinci robot-assisted lung resection from February to March 2021 were retrospectively analyzed. There were 10 males and 11 females, with a median age of 50 (34-66) years. The operation time, blood loss, postoperative hospitalization time, postoperative complications and other indicators were analyzed. Results    All patients completed the operation successfully with no transition to thoracotomy or perioperative death. Overall surgery time was 103 (70-200) min, Docking time was 5 (3-10) min, operation time was 81 (65-190) min. The blood loss was 45 (20-300) mL. All patients had malignant tumors, the number of dissected lymph node station was 3 (1-6), and the number of lymph nodes was 5 (2-16). The postoperative indwelling time was 3 (2-5) d. The postoperative hospitalization time was 5 (3-7) d. The pain score for the first 3 days after surgery was 3±1 points. Conclusion    Single utility port robot-assisted lung resection via anterior approach is safe, less traumatic, more convenient and effective, which can be gradually promoted and applied to clinical trials.

A comparative study on the clinical effects of hip arthroplasty through direct anterior approach in lateral decubitus in the treatment of hip osteoarthritis caused by Kaschin-Beck disease and congenital acetabular dysplasia / 中华地方病学杂志

Objective:To compare the clinical effects of hip arthroplasty through direct anterior approach (DAA) in lateral decubitus in the treatment of hip osteoarthritis caused by Kaschin-Beck disease and congenital acetabular dysplasia.Methods:The prospective study method was used to select the patients who needed hip arthroplasty in the Fourth Department of Orthopedics, the Second Affiliated Hospital of Harbin Medical University from January 2015 to December 2019. All of them were operated with lateral decubitus DAA. According to the inclusion criteria, they were divided into Kacshin-Beck disease hip osteoarthritis group (group A) and congenital acetabular dysplasia hip osteoarthritis group (group B). Hip Harris score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, visual analogue scale (VAS) score were conducted, and hip abduction angle and flexion angle were measured before surgery, 3, 14 days and 1, 3, and 12 months after surgery.Results:Nineteen and twenty-two patients were included in group A and group B, respectively. All patients successfully completed the surgery. There was no significant difference in Harris score between the two groups before surgery, 3, 14 days, and 1, 12 months after surgery ( P > 0.05). There were no significant differences in WOMAC score, VAS score, hip abduction angle and hip flexion angle between the two groups before surgery and each time point after surgery ( P > 0.05). In the same group, there were significant differences in Harris score, WOMAC score, VAS score, hip abduction angle and hip flexion angle at different time points ( P < 0.001). All postoperative indicators were significantly improved compared with those before surgery. Conclusions:There is no significant difference in the clinical effects of hip arthroplasty through lateral decubitus DAA in the treatment of hip osteoarthritis caused by Kaschin-Beck disease and congenital acetabular dysplasia. This surgical method has good therapeutic effect on both types of hip osteoarthritis.

Abordaje anterior de la cadera: historia y beneficios / Anterior Approach to the Hip: History and Benefits

La artroplastia de cadera es uno de los tratamientos quirúrgicos más exitosos en la cirugía ortopédica. Actualmente existe un mayor interés en el abordaje anterior para artroplastias de cadera determinado por la creencia de que al ser intermuscular puede provocar una disminución del dolor, una recuperación más rápida, mejor estabilidad de la cadera y menor riesgo de luxación después de la cirugía comparativamente. Es propósito de este artículo revisar la historia del abordaje anterior de la articulación de la cadera, su vía intermuscular de acceso y los principales beneficios que posee. Popularizado por Smith-Petersen en 1917, el abordaje anterior de la cadera debe su primera referencia escrita a Carl Hueter. Todos los abordajes de la cadera han demostrado ser seguros y eficaces, con ventajas y desventajas. Se requieren estudios a largo plazo de un mayor número de pacientes para demostrar un beneficio de costo y una mayor calidad en la atención médica(AU)

Hip replacement is one of the most successful surgical treatments in orthopedic surgery. There is currently greater interest in the anterior approach to hip arthroplasties determined by the belief that being intramuscular it can lead to less pain, faster recovery, better hip stability and comparatively less risk of dislocation after surgery. The purpose of this article is to review the history of the anterior approach to the hip joint, its intramuscular access route and its main benefits. Popularized by Smith-Petersen in 1917, the anterior approach to the hip owes its first written reference to Carl Hueter. All hip approaches have been shown to be safe and effective, with advantages and disadvantages. Long-term studies of larger numbers of patients are required to demonstrate cost benefit and higher quality of medical care(AU)

Comparación de resultados entre el abordaje anterior y posterior en la artroplastia total de cadera / Comparing Results between the Anterior and Posterior Approach in Total Hip Arthroplasty

Introducción: Existe una gran controversia con respecto a la existencia de un abordaje quirúrgico óptimo para artroplastia de cadera. El énfasis actual en la investigación ha sido examinar las posibles diferencias en los resultados funcionales entre el abordaje anterior y el abordaje posterior. Objetivo: Comparar las medidas de resultado informadas por los pacientes sometidos a artroplastia total de cadera, mediante abordajes anterior y posterior. Métodos: Se realiza una búsqueda sobre el tema en la base de datos PubMed entre los años 2010-2020 en inglés con los términos: comparación entre abordaje anterior y abordaje posterior de la cadera, abordaje anterior directo de la cadera, abordaje posterior de la cadera, y resultados de artroplastia de la cadera mediante abordajes anterior y posterior. Análisis y síntesis de la información: El abordaje anterior muestra una mayor mejora en la velocidad de la marcha, la longitud del paso y la simetría de la marcha, en comparación con el abordaje posterior para artroplastia de cadera al mes después de la operación. A los cuatro meses estas características de la marcha no fueron diferentes, pero los resultados de algunas pruebas funcionales fueron superiores en los pacientes intervenidos por abordaje anterior. Conclusiones: La elección del abordaje quirúrgico para artroplastia de cadera debe basarse en los factores del paciente, la preferencia del cirujano y su experiencia(AU)

Introduction: There is great controversy regarding the existence of an optimal surgical approach for hip arthroplasty. The current research emphasis has been to examine the possible differences in functional outcomes between anterior and posterior approaches. Objective: To compare the outcome measures reported by patients undergoing total hip arthroplasty, using anterior and posterior approaches. Methods: A search is carried out on the subject in the PubMed database during the years 2010-2020, in English, with the terms comparison between anterior approach and posterior approach to the hip, direct anterior approach to the hip, posterior approach to the hip, and results of hip arthroplasty using anterior and posterior approaches. Analysis and synthesis of the information: The anterior approach showed greater improvement in gait speed, stride length and gait symmetry, compared to the posterior approach for hip arthroplasty one month after the operation. At four months, these gait characteristics were not different, but the results of some functional tests were superior in patients operated on by anterior approach. Conclusions: The choice of the surgical approach for hip arthroplasty should be based on the patient´s factors, preference of the surgeons and their experience(AU)

Comparison Of Anterior And Posterior Approach Of Percutaneous Catheterization Of Internal Jugular Vein Under Real Time Ultrasound Guidance In Critically Ill Patients: A Prospective Randomised Study

Background:Central venous catheterization is a vital intervention in critically ill patients. The purpose of this study was to compare the procedural parameters and complications associated with anterior and posterior approaches of IJV catheterization under real timeultrasound guidance in critically ill patients. Material And Methods:In this prospective randomised study, 90 patients admitted in various ICUs were randomly allocated two groups of 45 each, including both males and females aged between 18 to 80 years ofage requiring central venous catheterization for various indications. Result:The first attempt success rates were comparable between both the groups. The venous visualization time was 38.52 seconds in Group A and 14.65 seconds in Group P (p<0.001). The venous puncture time and the duration of catheterization was found to be 47.60 sec & 2 minutes in Group A respectively and 24.16 sec & 1 minute 32 sec in Group P respectively (p<0.001). No statistically significant differences were found between the two groups in terms of incidence of carotid arterial puncture, haematoma formation and catheter displacement.Conclusion:It was observed that the posterior approach is better than anterior approach of USG guided IJV catheterization as it improves the accuracy, reduces the access time and duration of catheterization & leads to fewer incidences of immediate complications like carotid arterial puncture & subseque nt haematoma formation.

Modified pararectus abdominis approach for anterior plate fixation of sacral fracture: a clinical anatomy study / 中华创伤骨科杂志

Objective:To investigate the safety and feasibility of modified pararectus abdominis approach in the anterior plate fixation of sacral fractures.Methods:In 5 fresh adult cadavers (3 males and 2 females), gross anatomy was performed on one pelvic side using a modified pararectus abdominis approach to clarify the anatomical structures around the approach. On the other side of the pelvis, the anterior structures of the sacrum were exposed in simulated anterior plate fixation of sacral fracture via the modified pararectus abdominis approach. The exposed anatomic range of the approach, and the locations and courses of lumbosacral trunk nerve and iliac vessels were observed and recorded.Results:(1) The modified pararectus abdominis approach exposed the whole S1 vertebral body from the sacroiliac joint to the medial side, the L5 vertebral body cephalally, the S1 foramina in the true pelvis, and the same structures laterally as a traditional pararectus abdominis approach did. (2) Via the modified pararectus abdominis approach, exploration and decompression of the lumbosacral plexus (from L4 to S1) (including S1 foraminoplasty) were performed under direct vision to decompress the nerve entrapment from anterior compressed fracture fragments and hyperplastic callus. (3) There was a safe surgical area in anterior L5 and S1 where a plate could be safely fixed to the S1 vertebral body. (4) Since the maximum vertical distance from the lumbosacral trunk nerve lifted above the periost to the sacral ala was 1.4 cm (range, from 1.2 to 1.5 cm), a plate could be safely placed from the subperiosteum to the S1 vertebral body to fix the fracture.Conclusions:The modified pararectus abdominis approach is safe and feasible for exploration and decompression of lumbosacral nerves in the anterior sacral region (from L4 to S1) because it has significant advantages in vision and operation. It also broadens the range of anterior sacral plate fixation because a sacral fracture displacement can be reduced under direct vision and a plate can be fixated to the S1 vertebral body along the alae sacralis and across the sacroiliac joint to the iliac bone.