Steffen R, O'Rourke K, Gill H S, Murray D W
Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK.
J Bone Joint Surg Br. 2007 Oct;89(10):1293-8. doi: 10.1302/0301-620X.89B10.18974.
In 12 patients, we measured the oxygen concentration in the femoral head-neck junction during hip resurfacing through the anterolateral approach. This was compared with previous measurements made for the posterior approach. For the anterolateral approach, the oxygen concentration was found to be highly dependent upon the position of the leg, which was adjusted during surgery to provide exposure to the acetabulum and femoral head. Gross external rotation of the hip gave a significant decrease in oxygenation of the femoral head. Straightening the limb led to recovery in oxygen concentration, indicating that the blood supply was maintained. The oxygen concentration at the end of the procedure was not significantly different from that at the start. The anterolateral approach appears to produce less disruption to the blood flow in the femoral head-neck junction than the posterior approach for patients undergoing hip resurfacing. This may be reflected subsequently in a lower incidence of fracture of the femoral neck and avascular necrosis.
在12例患者中，我们通过前外侧入路在髋关节表面置换术中测量了股骨头 - 颈交界处的氧浓度，并将其与先前通过后外侧入路测得的结果进行比较。对于前外侧入路，发现氧浓度高度依赖于腿部位置，术中需调整腿部位置以暴露髋臼和股骨头。髋关节极度外旋会使股骨头的氧合显著降低。伸直肢体可使氧浓度恢复，这表明血供得以维持。手术结束时的氧浓度与开始时无显著差异。对于接受髋关节表面置换术的患者，前外侧入路似乎比后外侧入路对股骨头 - 颈交界处血流的干扰更小。这随后可能反映为股骨颈骨折和缺血性坏死的发生率较低。
