| Objective: To investigate the extent of damage to the tensor fasciae latae(TFL)during direct anterior approach(DAA)in total hip arthroplasty,and its effect on early postoperative function and muscle strength recovery of patients.In order to further confirm the necessity and importance of TFL protection in the DAA approach.Methods: According to the selection criteria,53 patients who were treated in our hospital from December 2020 to December 2021,and who were evaluated for THA surgery were included in this study.The degree of TFL injury was measured during the operation,and the patients were divided into two groups,A and B,according to the degree of TFL injury.Group A: The long axis of the complete tear section of TFL is less than 1cm;Group B: the long axis of the complete tear section of TFL is greater than or equal to 1 cm.Muscle strength of TFL and GMed,muscle fatigue of TFL were measured by surface electromyography before and after surgery,and muscle injury markers,inflammatory factors,preoperative and postoperative Harris scores,degree of swelling of affected thighs,Trendelenburg signs,VAS scores,and position of acetabular prosthesis were studied in the two groups of patients.Results: By the end of the study,3 patients did not have postoperative review on time;1 patient refused the last s EMG test;One patient was lost to follow-up,and data of 48 patients were collected completely.There were 22 patients in group A and 26 patients in group B.(1)The general data of the two groups of patients,such as age(p=0.725),body mass index(BMI)(p=0.172),etiology(p=0.398)and gender(p=0.961),were not statistically significant before surgery significance.(2)There was no significant difference in preoperative CK,LDH and hs CRP between the two groups(p=0.214,p=0.950,p=0.725).There were no significant differences in preoperative CK,LDH and hs CRP between 2groups(P =0.214,P =0.950,P =0.725).But there were statistically significant differences in CK,LDH and hs CRP between the two groups of TFL tearing patients on postoperative day 1,day 3 and day 5(P =0.030,P=0.020,P =0.011;P = 0.014,P =0.001,P =0.028;P =0.035,P =0.045,P=0.006).(3)There was no significant difference in the volume of affected thigh between the two groups before surgery(P =0.341),and no significant difference in the swelling of affected thigh on the day 1 after surgery(P=0.363).On postoperative day 3 and day 5,there was statistical significance in thigh swelling between the two groups(P =0.045,P=0.004),and the volume was larger than that before.One month after surgery,there was no significant change in thigh volume(P =0.352),but the volume in both groups increased compared with that before the surgery.(4)The volume of affected thigh before surgery and the 1st day after was statistically significant(P =0.341,P =0.363).On postoperative day 3and postoperative day 5,there was statistical significance in thigh swelling between the two groups(P =0.045,P =0.004),and the volume was larger than that before surgery.One month after surgery,there was no significant change in thigh volume(P =0.352),but the volume in both groups increased compared with that before.(5)The preoperative positive cases of Trendelenburg sign in the two groups accounted for 69.1% and 69.2% of the total cases,respectively.There was no significant difference between the two groups before operation(p=0.938).The number of patients with Trendelenburg sign(-)in group A after operation was more,and Statistically significant(p=0.036).(6)There was no significant difference in TFL muscle strength between the two groups before surgery(p=0.804),and the changes on the 5th day and 1 month after surgery were statistically significant(p=0.000,p=0.007);There was no significant difference in GMed muscle strength before surgery,on the 5th day after surgery,and 1 month after surgery(p=0.679,p=0.482,p=0.396);TFL muscle strength in all patients before and after surgery There was statistical significance in the latter 1 month(p=0.000,p=0.003),and there was no statistical significance in the comparison of GMed muscle strength in all patients before and 1 month after surgery(p=0.070,p=0.066).(7)There was no significant difference in TFL muscle fatigue between the two groups before and 5 days after surgery(P =0.776,P =0.275),and TFL muscle fatigue has significant difference on 1 month after surgery(P=0.035).(8)The BMI of symptomatic patients was higher than that of asymptomatic patients,and the difference was statistically significant(p=0.030).The TFL muscle strength of symptomatic patients was lower than that of asymptomatic patients(p=0.001);there was no significant difference in GMed muscle strength between the two groups before and after surgery(p=0.212,p=0.901).The difference in patients with positive Trendelenburg sign was statistically significant(p=0.001).The two groups of patients were compared in different TFL injury groups,and the difference was statistically significant(p=0.025).(9)The abduction angle and anteversion angle of the acetabular prosthesis of all patients in this study were within the Lewinnek safety zone.Conclusion:(1)The degree of TFL injury in total hip arthroplasty by DAA was related to the early postoperative TFL muscle strength recovery of patients.Our study showed that the more serious TFL injury was,the slower TFL recovery was and the higher fatigue was.(2)Significant TFL injury during total hip arthroplasty can lead to slow recovery of limb function,swelling and pain of thigh;(3)Based on the above studies,TFL protection should be emphasized during TOTAL hip arthroplasty with DAA. |
