Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of RussiaТравматология и ортопедия России2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics160510.21823/2311-2905-2021-27-2-132-143ReviewsОбзорыReviewsMinimally Invasive Approaches for Total Hip Arthroplasty: Systematic ReviewМиниинвазивные доступы, применяемые при эндопротезировании тазобедренного сустава: систематический обзорhttps://orcid.org/0000-0001-9231-5891KorytkinA. A.КорыткинА. А.
Russian Federation

Andrey  A.  Korytkin —  Cand.  Sci.  (Med.), Director

Novosibirsk

Корыткин  Андрей  Александрович –  канд.  мед.  наук, директор  

г. Новосибирск

andrey.korytkin@gmail.comhttp://niito.ruhttps://orcid.org/0000-0002-3179-9770GerasimovS. A.ГерасимовС. А.
Russian Federation

Sergey  A.  Gerasimov —  Cand.  Sci.  (Med.)

Nizhny Novgorod

Герасимов  Сергей  Александрович –  канд.  мед.  наук, заведующий  ортопедическим  отделением  (взрослых) Университетской клиники

г. Нижний Новгород

gerasimoff@list.ruhttps://kneeandpelvis.ruhttps://orcid.org/0000-0001-9314-2881KovaldovK. A.КовалдовК. А.
Russian Federation

Kirill  A.  Kovaldov —  Orthopaedic surgeon

Nizhny Novgorod

Ковалдов  Кирилл  Александрович —  врач  травматолог-ортопед  Университетской  клиники

г. Нижний Новгород

kovaldovc@gmail.comhttps://kneeandpelvis.ruhttps://orcid.org/0000-0002-7026-5843GerasimovE. A.ГерасимовЕ. А.
Russian Federation

Evgeny  A.  Gerasimov —  PhD student, Orthopaedic surgeon

 Nizhny Novgorod

Герасимов  Евгений  Александрович —  аспирант,  врач травматолог-ортопед Университетской клиники

 г.  Нижний  Новгород

egerasimov2016@gmail.comhttps://kneeandpelvis.ruPronskikhA. A.ПронскихА. А.
Russian Federation

Alexander  A.  Pronskikh —  Cand.  Sci.  (Med.), Researcher, Department of Arthroplasty and Arthroscopy

Novosibirsk

 

Пронских Александр Андреевич— канд. мед. наук, научный сотрудник отделения эндопротезирования и эндоскопической хирургии суставов

Новосибирск

proal_88@mail.ruhttp://niito.ruNovikovA. V.НовиковА. В.

Alexander  V.  Novikov —  Dr. Sci. (Med.), Chief Researcher, Orthopaedic surgeon

Nizhny Novgorod

Новиков  Александр  Вульфович —  д-р  мед.  наук, главный  научный  сотрудник,  травматолог-ортопед Университетской клиники

г. Нижний Новгород

kneeandpelvis@yandex.ruhttp://www.nniito.ruhttps://orcid.org/0000-0001-7548-9398MorozovaE. A.МорозоваЕ. А.
Russian Federation

Ekaterina A.  Morozova —  administrator

Nizhny Novgorod

Морозова Екатерина Александровна— специалист по социальной  работе  Университетской  клиники

г.  Нижний  Новгород

ekaterina.m.96@mail.ruhttps://kneeandpelvis.ruTsivyan Novosibirsk Research Institute of Traumatology and OrthopaedicsФГБУ «ННИИТО им. Я.Л. Цивьяна» Минздрава РоссииFSBEI HE «Privolzhsky Research Medical University» MOH RussiaФГБОУ ВО «Приволжский исследовательский медицинский университет» Минздрава России130720212721321432903202104062021https://journal.rniito.org/jour/article/view/1605

Introduction. Main objective of total hip replacement (THR) is fast recovery of hip joint function and patient’s return to daily routines. Use of minimally invasive approaches (MIA) may help achieving set objective. The purpose of the study was to analyze and compare MIA in THR.

Materials and methods. Databases of PubMed, Scopus, Cochrane Systematic Reviews, Google Scholar and E-library were searched for the period since 2000 to 2020. 55 scientific articles were selected for the analysis. Publications contain results of studies of MIA, such as Direct Anterior Approach (DAA), Micro-Hip (MH), Röttinger (R), Mini-posterior (MP), Direct Superior Approach (DSA), SuperCap (SC), PATH (P), SuperPATH (SP). The initial data were combined and underwent statistical processing.

Results. A comparative analysis of MIA couldn’t identify superiority of any approach. Blood loss, length of hospital stay, functional outcomes (Harris Hip Score) at 3 and 12 months didn’t differ between the groups. Significant differences were found in the operation time between DSA and SP. Acetabular inclination was different between some approaches. Cup inclination in R and DSA, cup anteversion in DAA, MH and SP slightly exceeded Lewinnek's «safe zone». Recurrent dislocation, periprosthetic fractures, damage to the lateral cutaneous nerve are the most frequent postoperative complications.

Conclusion: THR can be done using a variety of surgical approaches. The choice of approach relies on surgeon’s experience and personal preferences. Minimally invasive approaches have the advantage of short-term recovery due to the preservation of soft tissues.

Введение. В настоящее время одной из важных задач в эндопротезировании тазобедренного сустава является быстрое восстановление функции сустава пациента и его скорое возвращение к обычному образу жизни. Особую роль в реализации данной задачи играет выбор хирургического доступа. Цель – проведение сравнительной оценки миниинвазивных доступов, применяемых при эндопротезировании тазобедренного сустава. Материалы и методы. Поиск тематических источников проводился в электронных базах данных PubMed, Scopus, Cochrane Systematic Reviews, Google Scholar и E-library за период с 2000 по 2020 г.г. Для анализа было отобрано 55 научных публикаций, в которых освещались результаты исследований по применению таких малоинвазивных доступов как Direct anterior approach, Micro-Hip, Röttinger, Mini-posterior, Direct superior approach, SuperCap, PATH, SuperPATH. Исходные данные были объединены и статистически обработаны с помощью параметрического анализа.

Результаты. Проведенный анализ результатов применения миниинвазивных доступов не смог выявить доказательства превосходства какой-либо одной из рассматриваемых техник. Показатели кровопотери, продолжительности пребывания пациента в стационаре, функциональные исходы согласно Harris Hip Score через 3 и 12 месяцев между группами статистически не различались. Статистически значимые отличия были найдены в продолжительности хирургического вмешательства между доступами Direct Superior approach и SuperPATH и в значениях угла инклинации вертлужного компонента между рядом групп. Значения угла инклинации у доступов Röttinger и Direct Superior approach, а также величина угла антеверсии вертлужного компонента у доступов Direct anterior approach, Micro-Hip и SuperPATH незначительно превзошли параметры «безопасной зоны» Lewinnek. Перелом вертлужной впадины в качестве интраоперационного осложнения был зафиксирован среди всех техник. Наиболее часто наблюдаемыми постоперационными осложнениями стали: вывих головки эндопротеза, перипротезный перелом, повреждение латерального кожного нерва бедра.

Заключение. Эндопротезирование тазобедренного сустава может быть выполнено с помощью различных техник. Выбор применяемого доступа в повседневной практике хирурга зависит от его опыта и подготовки, а также личных предпочтений. Преимуществами миниинвазивных техник является краткосрочное восстановление, которому способствует сохранение мягких тканей.

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