初學者使用改良型正前手術入路於半人工髖關節置換術的經驗

The Beginners’Experience of the Modified Direct Anterior Approach for Hip Hemiarthroplasty

近年來，越來越多的患者經由正前手術入路(DAA)接受髖關節置換術。正前手術入路的陡峭學習曲線及併發症的高發生率使該方法對新手骨科醫師更具挑戰性。在此研究中，我們展示了改良型正前手術入路方法並分析其相關的臨床結果及其併發症。我們回朔性分析從2019年1月至2019年7月之間的24例股骨頸骨折患者，所有患者均通過改良型正前手術入路方法接受了雙極半人工關節置換。既無術中醫源性骨折；也無術後關節脫位發生。僅一名患者(4%)有股骨外側皮神經症狀且於兩週後自動緩解。僅管正前手術入路的學習曲線相當陡峭，但可以根據前人經驗及在短時間內通過累積更多案例來克服。

In recent years, an increasing number of patients have received hip arthroplasty through a direct anterior approach (DAA). The steep learning curve of DAA and the high complication rate make the approach more challenging to the beginning surgeons. In this study, we aimed to describe our modified DAA method and to analyze its related clinical outcomes, and both perioperative and postoperative complications. Retrospectively we reviewed twenty-four patients with femoral neck fracture between Jan. 2019 and Jul. 2019, all treated with bipolar hemiarthroplasty through our modified DAA method. Neither intraoperative iatrogenic fracture nor postoperative dislocation was found. Only one patient (4%) had lateral femoral cutaneous nerve symptoms, which resolved spontaneously two weeks later. Although the learning curve of DAA is rather steep, it could be overcome in short time interval by accumulating more cases based on the predecessors’experience.