Mclauchlan入路髋关节置换的临床应用  

The Clinical Application of Mclauchlan Incision Approach for Artificial Coxa Arthrosis Replacement

作　　者：王俊峰[1] 王全贵[1] 李妍妍[1] 钟亚林[1] 陈传功[1] 

机构地区：[1]北京军区总医院医疗东区骨科,北京100026

出　　处：《实用骨科杂志》2011年第6期513-515,共3页Journal of Practical Orthopaedics

摘　　要：目的探讨Mclauchlan入路髋关节置换的临床应用及其方法改良。方法2002年1月至2007年4月采用Mclauchlan切口入路行髋关节置换168例181髋，其中全髋置换122例135髋，半髋置换46例46髋。男性96例104髋，女性72例77髋；年龄29～90岁，平均62岁。术中用骨刀将大粗隆的骨膜及连带大粗隆上的一薄层骨皮质连同臀中肌股外侧肌一并掀起，依次切开臀小肌与关节囊，可以充分暴露髋臼与股骨上端。结果随访6～36个月，平均16个月。得到随访的106例均在术后6～8d开始逐步负重行走，髋外展肌力良好，除有1例因患肢术前短缩置换术后仍行走跛行外，其余患者均无跛行。Trendelenburg试验（-），手术大粗隆切口区无明显不适，x线片显示大粗隆骨皮质愈合良好。术后3个月时Harris评分平均94．53分，较术前提高了24．68分。结论采用Mclauchlan切口，手术视野良好、创伤小、出血少，前无股血管之顾，后无坐骨神经之忧，其上也避免了臀上神经的损伤，操作简单，手术时间短，值得推广使用。Objective Summarize the clinical experiences of the replacement of artificial coxa arthrosis with Mclauchlan approach. Methods Since January 2002 to April 2007 there had been 168 cases with 181 coxas： 96 cases with 104 coxas for male and 72 cases with 77 coxas for female using Mclauchlan incision approach to replace coxa arthrosis. The age ranged from 29 to 90 years old with the average age of 62. These surgicals adopted Mclauchlan incision approaches,using bone knives to surge the periosteum of the great trochanter and the associated thin bone cortical with this great trochanter and completing these replacements. Results There were no vascular and nerve injuried and also no systemic and local complications appeared after the surgical. What more,the review of X ray indicated the prosthesis was just in the good position. The random visit had kept for 6-36 months,with an average of each 16 months ,all the patients of those 106 cases ,who received this visit ,could walk with load in vary extent in 6-8 weeks, and the expended muscle strength of coxa abduction was normal. Except that one case was still walking limply because of the broken part had shortened this replacement before surgical ,there had no limps for the remaining patients. Tren delenburg test （ I ） ：It appeared the head of thighbone was without dislocation,and there were no complications of prosthesis subsidised and loosened ,and so on. Three months after the surgical using Harts to grade ,the average score was 94.53. It increased 24. 68 scores comparing with the preoperation. Conclusion Using Mclauchlan incision,the surgical view was clear exposed ,the wound was small and with less bleeding. Not only there were no worrying about thigh vascular,but also no cares of sciatic nerve,which also avoided scathing nerves on the pygal,and the operation was simple and with short operation time ,it was worth of widely spreading.

关 键 词：手术入路 关节置换 髋关节 

分 类 号：R687.42[医药卫生—骨科学]