臨床整形外科51巻9号

2016年09月発行

誌上シンポジウム THAのアプローチ

Anterolateral-Supine Approach

著者： 中田活也¹ 北田誠¹ 田村理¹ 大脇肇¹ 冨士武史¹

所属機関： ¹地域医療機能推進機構大阪病院人工関節センター・整形外科

ページ範囲：P.809 - P.815

　Anterolateral(AL)-Supine approachによる人工股関節全置換術(THA)112関節を対象とした．手術時平均年齢：64.4歳，女性91例/男性12例，BMI：23.0kg/m²，原疾患：全例二次性変形性股関節症，平均追跡期間：37カ月であった．インプラント設置精度と安全性，脚長補正と関節安定性の獲得に関する手術手技の是非について検討した．カップ安全域内設置(Lewinnek)：98.2％，カップ外転角40±5°設置：76.8％，前稔角15±5°設置：69.7％，ステム前捻角：32.2°であった．術後脚長差(10mm未満)：92.1％，術後脱臼は認めなかった．AL-Supine approachにおいて，綿密な3D術前計画，正確なインプラント設置，術中脚長差の確認，筋間進入と適切なオフセットの選択による軟部組織緊張の保持により，過度な脚延長なく適切に脚長補正がなされ関節安定性も獲得された．

参考文献

1) Widmer KH, Zurfluh B. Compliant positioning of total hip components for optimal range of motion. J Orthop Res 2004;22:815-21.

2) Ito Y, Matsushita I, Watanabe H, et al. Anatomic mapping of short external rotators shows the limit of their preservation during total hip arthroplasty. Clin Orthop Relat Res 2012;470:1690-5.

3) 中田活也，山村在慶，冨士武史．Anterolateral-supine approachの治療経験−Direct anterior approachと比較して．Hip Joint 2011；37：184-7．

4) Nakata K, Nishikawa M, Yamamoto K, et al. A clinical comparative study of the direct anterior with mini-posterior approach. Two consecutive series. J Arthroplasty 2009;24:698-704.

5) Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 1978;60:217-20.

6) Crockett HC, Wright JM, Bonner KF, et al. Mini-incision for total hip arthroplasty. Scientific exhibit presentation. American Academy of Orthopaedic Surgeon, New Orleans, LA, March 1998．

7) 中村　茂，松田健太．小切開後方進入法による最小侵襲THA．整・災外2004；47：1549-53．

8) 中田活也，乾　浩明，渡邉　哲・他．強化型後方軟部組織修復法を併用したminimally invasive THAの早期臨床成績．骨・関節・靱帯2004；17：1345-52．

9) 松原正明，平澤直之．Minimally invasive surgeryによるcementless THAの周術期臨床成績．整・災外2004；47：1561-7．

10) 平川和男，長谷川　守，大沼　寧・他．MIS mini-one incision antero-lateral approachによる人工股関節置換術．100例の経験から．整・災外2004；47：1537-48．

11) Swanson TV. Early results of 1000 consecutive posterior single-incision MIS-THA. J Arthroplasty 2005;20:26-32.

12) Wright JM, Crockett HC, Delgado S, et al. Mini-incision for total hip arthroplasty. A Prospective, controlled investigation with 5-year follow-up evaluation. J Arthroplasty 2004;19:538-45.

13) Chimento GF, Pavone V, Sharrock N, et al. Minimally invasive total hip arthroplasty. A prospective randomized study. J Arthroplasty 2005;20:139-44.

14) O'Brien DAL, Rorabeck CH. The mini-incision direct lateral approach in primary total hip arthroplasty. Clin Orthop Relat Res 2005;441:99-103.

15) Ogonda L, Wilson R, Archbold P, et al. A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial. J Bone Joint Surg Am 2005;87:701-10.

16) Bal BS, Halton D, Aleto T, et al. Early complications of primary total hip replacement performed with a two-incision minimally invasive technique. J Bone Joint Surg Am 2005;87:2432-8.

17) de Beer J, Petruccelli D, Zalzal P, et al. Single-incision, minimally invasive total hip arthroplasty. Length doesn't matter. J Arthroplasty 2004;19:945-50.

18) Pour AE, Parvizi J, Sharkey PF, et al. Minimally invasive hip arthroplasty:What role does patient preconditioning play? J Bone Joint Surg Am 2007;89:1920-7.

19) Woolson ST, Mow CS, Syquia JF, et al. Comparison of primary total hip replacements performed with a standard incision or a mini-incision. J Bone Joint Surg Am 2004;86:1353-8.

20) Siguier T, Siguier M, Brumpt B. Mini-incision anterior approach does not increase dislocation rate. A study of 1037 total hip replacements. Clin Orthop Relat Res 2004;426:164-73.

21) Bertin KC and Rottinger H. Anterolateral mini-incision hip replacement surgery. Modified Watson-Jones approach. Clin Orthop Relat Res 2004;429:248-55.

22) Berger RA. Total hip arthroplasty using the minimally invasive two-incision approach. Clin Orthop Relat Res 2003;417:232-41.

23) Pospischill M, Mag AK, Knahr K. Minimally invasive compared with traditional transgluteal approach for total hip arthroplasty. J Bone Joint Surg Am 2010;92:328-37.

24) Matta JM, Shahrdar C, Ferguson T. Single-incision anterior approach for total hip arthroplasty on an orthpaedic table. Clin Orthop Relat Res 2005;441:115-24.

25) Oinuma K, Eingartner C, Saito Y, et al. Total hip arthroplasty by a minimally invasive, direct anterior approach. Oper Orthop Traumatol 2007;3:310-26.

26) Restrepo C, Parvizi J, Pour AE, et al. Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty 2010;25:671-9.

27) Klausmeier V, Lugade V, Jewett BA, et al. Is there faster recovery with an anterior or anterolateral THA? A pilot study. Clin Orthop Relat Res 2010;468:533-41.

28) Christensen CP, Jacobs CA. Comparison of patient function during the first six weeks after direct anterior or posterior total hip arthroplasty (THA):A randomized study. J Arthroplasty 2015;30:94-7.

29) Jewett BA, Collis DK. High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Relat Res 2011;469:503-7.

30) Goulding K, Beaule PE, Kim PR, et al. Incidence of lateral femoral cutaneous nerve neuropraxia after anterior approach hip arthroplasty. Clin Orthop Relat Res 2010;468:397-404.

31) Frye BM, Berend, KR, Lombardi Jr AV, et al. Do sex and BMI predict or does stem design prevent muscle damage in anterior supine minimally invasive THA? Clin Orthop Relat Res 2015;473:632-8.

32) 川崎雅史，玉井良樹，藤林孝義・他．DAAによるTHAの臼蓋コンポーネント設置−仰臥位臼蓋操作で骨盤の傾きが生じるか？．Hip Joint 2010；36：240-43．

33) Watts CD, Houdek MT, WagnerER, et al. High risk of wound complications following direct anterior total hip arthroplasty in obese patients. J Arthroplasty 2015;30:2296-8.

34) Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs. posterolateral approach for total hip arthroplasty. J Arthroplasty 2013;28:1634-8.

35) Maratt JD, Gagnier JJ, Butler PD, et al. No difference in dislocation seen in anterior vs. posterior approach total hip arthroplasty. J Arthroplasty 2016 (e-published).

36) Post ZD, Orozco F, Diaz-Ledezma C, et al. Direct anterior approach for total hip arthroplasty:indications, technique, and results. J Am Acad Orthop Surg 2014;22:595-603.

37) Rodriguez JA, Deshmukh AJ, Rathod PA, et al. Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach? Clin Orthop Relat Res 2014;472:455-63.

38) O'Brien S, Kernohan G, Fitzpatrick C, et al. Perception of imposed leg length inequality in normal subjects. Hip International 2010;20:505-11.

39) Mahmood SS, Mukka SS, Crnalic S, et al. The influence of leg length discrepancy after total hip arthroplasty on function and quality of life:A prospective cohort study. J Arthroplasty 2015;30:1638-42.