Roth Andreas, Venbrocks Rudolf A
Orthopädische Klinik am Rudolf-Elle-Krankenhaus Lehrstuhl für Orthopädie der Friedrich-Schiller-Universität Jena, Klosterlausnitzer Strasse 81, D-07607, Eisenberg, Germany.
Oper Orthop Traumatol. 2007 Dec;19(5-6):442-57. doi: 10.1007/s00064-007-1019-2.
Early postoperative mobilization and restoration of pain-free joint function by implantation of a total hip replacement through a standardized, minimally invasive approach regardless of the type of implant with the patient in the supine position.
Primary and secondary coxarthrosis. Femoral head necrosis.
Previously operated patients with deformities of the coxal end of the femur and extensive scarring.
Supine position. Skin incision anterior to the greater trochanter at the level of the interval between the tensor fasciae latae muscle and the iliotibial tract parallel to the acetabulum ascending slightly from distal to proximal. Incision of the iliotibial tract posterior to the interval. Coagulation of intersecting vessels. Blunt dissection to the femoral neck anterior to the gluteal muscles. L-shaped incision of the anterior capsule with the base at the lateral femoral neck. Femoral neck osteotomy and resection of the femoral head. Mobilization of the posterior capsule by incision at the junction with the femur. Insertion of Hohmann elevators to protect the tissue, dissection of the acetabulum and implantation of the acetabular component. In adduction, external rotation and hyperextension, dissection of the coxal end of the femur, and implantation of the prosthetic stem. After reduction, adaptive suture of the cranial capsular parts. Insertion of intraarticular Redon drains. Interrupted suture of the iliotibial tract. Subcutaneous Redon drains. Subcutaneous suture. Skin suture. Sterile dressing. Final radiologic evaluation in anteroposterior view.
Mobilization from postoperative day 1. Increased loading on the operated leg depending on local pain. Four-point gait from day 2-3. Stair-climbing from day 4.
From September 2004 to July 2006, 195 patients were operated on (105 women, 90 men, average age 64.4 years [37.1-88.4 years]). Average operating time 63 min (35-105 min). Average intraoperative blood loss 437 ml (20-800 ml). Postoperative follow-up of all patients at 3, 6, and 12 months, and then annually. Early restoration of full weight-bearing ability and range of motion within the first few weeks.
two postoperative periprosthetic fractures. No periarticular ossifications > Brooker II. No hematoma requiring revision. No neurologic deficits.
通过标准化的微创入路植入全髋关节置换假体，无论假体类型如何，使患者仰卧位，实现术后早期活动并恢复无痛关节功能。
原发性和继发性髋关节病。股骨头坏死。
既往股骨近端有手术史且伴有畸形及广泛瘢痕形成的患者。
仰卧位。在大转子前方、阔筋膜张肌与髂胫束之间的间隙水平做皮肤切口，平行于髋臼，由远至近稍向上倾斜。在间隙后方切开髂胫束。结扎交叉血管。钝性分离臀肌前方至股骨颈。在股骨颈外侧做基底的L形前关节囊切开。股骨颈截骨并切除股骨头。在与股骨交界处切开后关节囊进行松解。插入霍曼氏拉钩保护组织，髋臼松解并植入髋臼假体。在内收、外旋和过伸位，松解股骨近端并植入假体柄。复位后，对关节囊上部进行适应性缝合。插入关节内雷东引流管。间断缝合髂胫束。皮下放置雷东引流管。皮下缝合。皮肤缝合。无菌敷料包扎。术后行前后位X线片最终影像学评估。
术后第1天开始活动。根据局部疼痛情况增加患侧肢体负重。术后第2 - 3天开始四点步态行走。术后第4天开始爬楼梯。
2004年9月至2006年7月，共对195例患者进行了手术（105例女性，90例男性，平均年龄64.4岁[37.1 - 88.4岁]）。平均手术时间63分钟（35 - 105分钟）。平均术中失血量437毫升（20 - 800毫升）。所有患者均在术后3个月、6个月和12个月进行随访，之后每年随访一次。术后几周内早期恢复完全负重能力和活动范围。
2例术后假体周围骨折。无大于布鲁克二级的关节周围骨化。无需要翻修的血肿。无神经功能缺损。
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