Michel Markus C, Witschger Pierre
Münsingen Orthopaedic Centre, Switzerland.
Ortop Traumatol Rehabil. 2007 Jan-Feb;9(1):46-51.
This article presents an anterior, minimally invasive surgical approach to the hip joint, aligned along an inter-nervous plane. Positioning in lateral decubitus position on a regular operation table obviates the need for a special orthopedic or fracture table. Traction is not applied. Most of the instruments used for this procedure are standard instruments for reaming of the acetabulum and positioning of the cup; specific, angulated instruments are recommended at least for obese patients. Using an incision of < 6-8 cm, this MI approach provides a perfect view of the acetabulum and proximal femur,including natural landmarks for proper implant positioning. The approach follows the gap between the tensor muscle and the gluteus medius muscle, using part of the anterior ilo-femoral Smith-Peterson approach. No tendons or muscles are cut or detached. The joint capsule is split and left in place. The hip joint is not dislocated; we perform the osteotomy of the femoral neck in situ. To date we have performed several hundred MicroHip operations, with no nerve lesions or trochanter fractures. Definitive results are not yet available, but our experience to date shows that this method can be used with virtually any patient, while such factors as hospitalization time, pain, blood loss and work incapacity can be cut almost in half. The MicroHip technique, used by an increasing number of clinics around the world, can be successfully applied by good surgeons after suitable training.
本文介绍了一种沿神经间隙平面的髋关节前路微创外科手术方法。在常规手术台上采用侧卧位，无需特殊的骨科或骨折手术台。不进行牵引。该手术使用的大多数器械是髋臼扩孔和髋臼杯置入的标准器械；至少对于肥胖患者，建议使用特定的成角器械。通过小于6 - 8厘米的切口，这种微创方法能完美地观察髋臼和股骨近端，包括用于正确植入物定位的自然标志。该方法沿着阔筋膜张肌和臀中肌之间的间隙，采用部分髂股前路史密斯 - 彼得森入路。不切断或分离肌腱或肌肉。切开关节囊并保留原位。不脱位髋关节；我们在原位进行股骨颈截骨术。迄今为止，我们已进行了数百例微创髋关节手术，未出现神经损伤或转子骨折。确切结果尚未可得，但我们目前的经验表明，这种方法几乎适用于任何患者，同时住院时间、疼痛、失血和工作能力丧失等因素几乎可减半。微创髋关节技术在世界各地越来越多的诊所得到应用，经过适当培训的优秀外科医生可以成功应用该技术。
