人工骨頭置換術における前外側進入法の有用性―後外側進入法との比較検討

Utility of the Anterolateral Approach for Hip Hemiarthroplasty. A Comparative Study with the Posterolateral Approach

　背景：人工骨頭置換術において，手術進入法の違いによる術後短期成績への影響を検討した．

　対象と方法：大腿骨頚部骨折に対して人工骨頭置換術を行った30例のうち，後外側進入法を行った例11股(PL群)と前外側進入法を行った例19股(AL群)を比較した．

　結果：手術時間はAL群でやや長かったが，出血量に差はなかった．ステム設置アライメントはAL群で軽度屈曲外反位に設置される傾向であった．

　まとめ：術後早期の歩行能力は，AL法がやや良好な傾向であった．AL法は手術に若干のコツを要するが，早期離床が期待できる有用な進入法と考えられた．

　Background：We retrospectively analyzed the short-term outcomes of hip hemiarthroplasty performed by two different approaches, a posterolateral (PL) approach and an anterolateral (AL) approach.

　Method：Thirty patients scheduled for hip hemiarthroplasty were divided into two groups, a group of 11 patients in whom the PL approach was used (PL group) and a group of 19 patients in whom the AL approach was used (AL group).

　Outcome：Operative time was significantly longer in the AL group, but there were no significant differences between the groups in intraoperative blood loss, postoperative gait recovery, or range of motion of the hip.　Alignment of the stem was within the acceptable range in both groups, but a greater tendency foward slightly flexed and valgus implantation was observed in the AL group.

　Conclusion：The short-term outcomes of hip hemiarthroplasty by the AL approach were comparable the short-term outcomes by the PL approach.　The AL approach may have accelerated postoperative recovery of ambulatory function.