小切口全髋关节置换术  

Small incision total hip arthroplasty

作　　者：程力[1] 顾晓峰[1] 张成玉[1] 朱浩明[1] 

机构地区：[1]无锡市第一人民医院骨科,无锡214000

出　　处：《中国微创外科杂志》2005年第5期390-392,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨侧前方小切口入路全髋关节置换术的可行性. 方法 2003年2月～2003年12月,采用前外侧小切口对53例58个髋关节行全髋置换术,其中5例为双侧同时手术,6例全髋关节翻修手术,4例关节完全强直的置换术.改良要点:平卧位,患侧半边臀部略悬空于手术床边,使臀大肌自然下垂,患侧下肢内收10°,使大粗隆突出部份充分暴露;股骨颈及大粗隆暴露后,先截骨,再脱位取出股骨头. 结果手术切口长度7～12 cm,平均8.5 cm.手术时间70～140 min,平均88 min.出血量250～660 ml,平均470 ml.无严重并发症.术后6～14 d部分负重行走.全部病例获得4～40周随访,平均28周,Harris评分优37例,良12例,中4例,优良率达92.5%(49/53). 结论侧前方小切口全髋关节置换术可行,具有创伤小、出血少、恢复快等优点,其应用范围可扩展到人工髋关节翻修、髋关节强直、髋关节先天脱位的人工全髋关节置换手术中.Objective To investigate the feasibility of total hip arthroplasty through a small anterolateral incision. Methods Total hip arthroplasty through a small anterolateral incision was performed in 53 cases (58 hip joints) from February 2003 to December 2003, including 5 cases of simultaneous replacement of bilateral joints, 6 cases of total hip revision, and 4 cases of hip joint rigidity. The surgical modification features were as follows: the patient was placed in recumbent position, with the involved buttock region slightly hanging over the side of the surgical bed and normally drooping; the involved leg was placed in 10° of adduction, which was helpful to the exposure of the greater trochanter; after the exposure of the neck of the femur and the greater trochanter, osteotomy was performed firstly, then the femoral head was dislocated and removed. Results The length of incision was 7~12 cm (mean, 8.5 cm). The operation time was 70~140 min (mean, 88 min). The blood loss was 250~660 ml (mean, 470 ml). No severe complications occurred. Postoperatively, weight-bearing and mobilization exercise were begun in 6~14 days. All the cases were followed for 4~40 weeks (mean, 28 weeks). The Harris hip scores showed excellent outcomes in 37 cases, good in 12, fair in 4, with a rate of excellent or good results of 92.5% (49/53). Conclusions Total hip arthroplasty through a small anterolateral incision is a feasible procedure that is characterized with minimal invasion, less blood loss and quick recovery. It can be applied in total hip replacement for artificial hip joint revision, hip joint rigidity, or congenital dislocation of hip joint.

关 键 词：髋关节 关节置换 小切口 

分 类 号：R687.3[医药卫生—骨科学]