Rachbauer Franz, Krismer Martin
Universitätsklinik für Orthopädie, Anichstrasse 35, 6020, Innsbruck, Osterreich.
Oper Orthop Traumatol. 2008 Sep;20(3):239-51. doi: 10.1007/s00064-008-1306-y.
Minimally invasive total hip arthroplasty via direct anterior approach aims at reducing soft-tissue damage, diminishing blood loss and postoperative pain, shortening stay in hospital, accelerating rehabilitation, and keeping scars small.
The technique is suitable for primary and secondary osteoarthritis as well as fractures of the femoral neck. Complex distortions of the proximal femur should be exempted.
Complex malalignment of the proximal femur.
The femoral neck is exposed in the interval between tensor fasciae latae, glutei medius and minimus muscles laterally, and sartorius and rectus femoris muscles medially. After osteotomy of the neck and extraction of the head the acetabulum is reamed to prepare for cup prosthesis. Following peritrochanteric capsulotomy the externally rotated, adducted and elevated femor is broached. Cemented and cementless implants may be used.
The patients are allowed to walk full weight bearing beginning on the 1st postoperative day. As soon as they are able to safely master the transfers and stairs, they are discharged.
The method is a safe procedure that allows correct placement of acetabular and femoral components. It may be performed in a reasonable time, the blood loss is little. The procedure preserves the muscles and leads to small, cosmetically pleasing scars. Patients usually do not suffer from pronounced pain, rehabilitation is accelerated. They therefore agree in an short postoperative stay in hospital.
直接前路微创全髋关节置换术旨在减少软组织损伤、减少失血和术后疼痛、缩短住院时间、加速康复并缩小疤痕。
该技术适用于原发性和继发性骨关节炎以及股骨颈骨折。股骨近端的复杂畸形应排除在外。
股骨近端复杂的排列不齐。
在阔筋膜张肌、臀中肌和臀小肌外侧与缝匠肌和股直肌内侧之间的间隙暴露股骨颈。在股骨颈截骨并取出股骨头后，对髋臼进行扩髓以准备髋臼假体。在转子周围关节囊切开术后，对外旋、内收和抬高的股骨进行扩髓。可使用骨水泥型和非骨水泥型植入物。
术后第1天开始允许患者完全负重行走。一旦他们能够安全地掌握转移和上下楼梯的方法，即可出院。
该方法是一种安全的手术，可正确放置髋臼和股骨假体。手术可在合理时间内完成，失血少。该手术保留了肌肉，留下的疤痕小，美观。患者通常不会遭受明显疼痛，康复加速。因此，他们术后住院时间短。
