Kennon R E, Keggi M J, Keggi K J
Department of Orthopaedics and Rehabilitation, University School of Medicine, Yale, New Haven, CT 06708, and Waterbury Hospital Health Center, USA.
Orthopade. 2006 Jul;35(7):731-7. doi: 10.1007/s00132-006-0965-3.
A modified anterior approach to the hip developed by the senior author has been utilized in performing over 7000 hip replacement operations at this joint replacement center in the past three decades. It can be readily applied to both primary and revision surgery, and involves muscle splitting and sparing of the major hip muscles, innervation, and function. Since the late 1970s, Yale orthopaedic residents have been taught this minimally invasive anterior approach using one, two, or three mini-incisions without fluoroscopy, special operating room tables, or special retractors. The authors' overall experience has documented a very low incidence of dislocation and minimal perioperative complications. While a smaller skin incision is desirable by patients for cosmetic reasons and decreased healing time, what goes on beneath the skin is far more important. A well-placed total hip replacement should never be compromised. While many of these patients can ambulate the same or first postoperative day quite well, the authors do not advocate outpatient total hip arthroplasty as some proponents have. Bone is still cut, tissues bleed, clots can form, and the traditional complications of arthroplasty, while reduced, can still occur.
在过去三十年里，资深作者所开发的改良髋关节前路入路，已在该关节置换中心应用于超过7000例髋关节置换手术。它可轻松应用于初次手术和翻修手术，涉及肌肉劈开以及保留主要髋关节肌肉、神经支配和功能。自20世纪70年代末以来，耶鲁大学骨科住院医师就开始学习这种微创前路入路，采用一、二或三个小切口，无需使用透视、特殊手术台或特殊牵开器。作者的总体经验表明，脱位发生率极低，围手术期并发症极少。虽然出于美观原因和缩短愈合时间，患者希望有更小的皮肤切口，但皮肤下的情况更为重要。放置得当的全髋关节置换术绝不应受到影响。虽然许多此类患者在术后同一天或第一天就能很好地行走，但作者并不像一些支持者那样提倡门诊全髋关节置换术。骨头仍需切割，组织会出血，会形成血凝块，关节置换术的传统并发症虽有所减少，但仍可能发生。
