The Risk Evaluation Of Two Kinds Of Surgical Approaches In Hip Orthroplasty

Objective: With the deepening of biomechanical researches, constantly updating of prosthesis design, extending of lifecycle and increasingly maturing of surgical technologies, The scope of application of artificial hip orthroplasty is extending. It can shorten the patients’ bed time, speed up patients’ functional recovery after surgery and reduce the complications caused by femoral neck fracture effectively. Therefore, the artificial hip orthroplasty has been widely recognized by more and more patients with femoral neck fracture. According to a retrospective analysis of hip orthroplasty performed through different clinical operative approaches, this research is to quantitatively compare modified anterolateral approach with posterior approach in terms of operating time and blood loss and to discuss the risks of these two kinds of surgical approaches in hip orthroplasty.Methods: A retrospective analysis was conducted for patients with femoral neck fracture who were admitted into The Third Hospital of Hebei Medical University and underwent hip orthroplasty from March 2011 to January 2015. 120 of these patients(69 males and 51 females) were randomly selected by excluding the dysplasia, avascular necrosis, arthritis, old fracture, multiple fractures, postoperative renovation and so on, with their ages ranging from 45 to 91 years old. Patients were divided into observation group(modified anterolateral approach) and control group(posterior approach) on the basis of surgical approach, 60 cases for each group. Patients in the two groups showed no significant differences in sex, age, cause of injury, combined disease, etc. The two groups were compared in terms of operating time and blood loss. Observation group: With the use of anterolateral approach, a curved incision was made centering on the greater trochanter tip to slice through the subcutaneous tissue to the femoral fascia when the patient was on flexed lateral decubitus position. Then, the subcutaneous tissue was cut open to go deep in the underlying bursa, the femoral fascia and the iliotibial band were split in the direction of the tensor fascia lata muscle fiber. Next, the gluteus medius, gluteus minimus and vastus lateralis were separated from each other by blunt dissection. Three acetabulum draw hooks were put on the inferior and lateral femoral neck and the acetabular roof to form a three-point distribution, and then joint capsule was split in U shape along the anterior basilar part of the femoral neck so that the femoral head and femoral neck could be touched with hand and exposed. After cutting the joint capsule, femoral neck was stripped away. At this time, an adequate exposure of the femoral head and its facture surface could be achieved. The residual femoral head was taken out with a head picker. Then, the hip joint was bent, inclined inward and rotated outward, and the patient was required to bend his or her knees so that the bone cutting surface of the basilar part of the femoral neck could face towards the front of the operative field. At this point, the bone cutting surfaces of the acetabulum and the basilar part of the femoral neck were exposed adequately in order to install the artificial hip joint. Control group: With the use of posterior approach, incisions were made centering on the greater trochanter tip to the distal extent along the femoral shaft, as well as the proximal end extending to the posterior superior iliac spine. Then, after incisions were made on the skin and subcutaneous tissue, the gluteus maximus and the tensor fascia lata were separated from each other by blunt dissection to achieve the exposure of the lateral femoral muscle, while the gluteus maximus and deep fascia were split from each other by blunt dissection. The hip joint was inclined inward with knees bent, so as to achieve the exposure of piriformis, superior gemellus, internal obturator muscle, and inferior gemellus. Sutures were used to close it up and hold these muscle groups. Torchanter tips on the abovementioned muscles and their recess insertions were cut out before slicing through the joint capsule to expose the femoral neck. The length of the femoral neck to be desected was identified by touching the lesser trochanter with hand. The desected femoral neck was rotated to expose the round ligament which was then cut off with tissue scissors. Then, the femoral head was pulled out to expose the bottom of acetabulum. At this time, the artificial hip joint could be installed.Results: The results of the homogeneity tests of variance for operating time in the two groups showed t=-0.699,P=0.486>0.05, suggesting that there was no significant difference in operating time between the abovementioned two surgical approaches(T test, P>0.05). The result of blood loss showed t=-2.322,P=0.022<0.05, suggesting that there was a statistically significant difference in blood loss between the abovementioned two surgical approaches(T test, P<0.05). Moreover, it could be seen from the mean value that the modified anterolateral approach caused less blood loss than the posterior approach.Conclusion: For hip replacement in treatment of femoral neck fracture, anterolateral approach and posterior approach are the most common surgical approaches. The risk of hip orthroplasty depends on how to control operating time and blood loss, which is very important for patients to live through the operative period safely. Therefore, in the premise of performing successful hip orthroplasty, how to reduce operating time, control blood loss and reduce operation wounds should be the common goal of all orthopedists who aim to provide safer and better surgical options. In terms of operating time, modified anterolaterial approach and posterior approach showed no obvious difference; however, there was statistically significant difference in blood loss between the two groups. It can be seen from the mean value that the blood loss of modified anterolaterial approach was much lower than that of posterior approach, suggesting that posterior approach posterior approach in artificial hip orthroplasty brings about a higher risk than anterolaterial approach.Thus, it is recommended to select modified anterolateral approach in artificial hip joint replacement for patients with poor physical condition and poor tolerance.