Sandri Andrea, Regis Dario, Magnan Bruno, Luminari Elisa, Bartolozzi Pietro
Department of Orthopedic Surgery, Verona University School of Medicine, Verona, Italy.
Orthopedics. 2009 Jun;32(6):406. doi: 10.3928/01477447-20090511-09.
Hip resurfacing is commonly performed using a posterior approach, although some authors have advocated damage to the vascular supply due to posterolateral capsulectomy as one of the possible causes of femoral neck fracture. The need to preserve blood supply has led to the use of an alternative surgical vascular-sparing procedure. This article describes early clinical and radiological outcomes of hip resurfacing via an anterolateral Watson-Jones approach in the supine position. Twenty-eight hips in 26 patients with degenerative hip disease were evaluated retrospectively with a mean follow-up of 28 months (range, 12-61 months). The mean age at surgery was 58 years (range, 26-72 years). The average Harris Hip Score increased from 60 points preoperatively (range, 30-69 points) to 96 points at latest follow-up (range, 80-100 points). Complications included femoral neurapraxia and deep vein thrombosis in 1 patient, which both resolved. One hip required revision due to acetabular cup loosening 15 months postoperatively. No progressive radiolucencies, avascular necroses, or dislocations were observed. Heterotopic ossifications were detected in 3 hips. The absence of early femoral failures in our series may be related to careful patient selection and a proper surgical technique. The anterolateral Watson-Jones approach in the supine position provides optimal exposure of the acetabulum and proximal femur, but a wide soft tissue release is always necessary. We preserve the posterolateral neck capsule to improve the chances of maintaining the blood supply to the femoral neck, even if no differences in clinical outcomes and complications are evident between the anterolateral and posterolateral approaches.
髋关节表面置换术通常采用后路进行，尽管一些作者认为后外侧关节囊切除术导致血管供应受损是股骨颈骨折的可能原因之一。出于保留血供的需要，人们采用了一种替代性的保留血管的手术方法。本文描述了仰卧位经前外侧Watson-Jones入路进行髋关节表面置换术的早期临床和影像学结果。对26例患有退行性髋关节疾病的患者的28个髋关节进行了回顾性评估，平均随访28个月（范围为12 - 61个月）。手术时的平均年龄为58岁（范围为26 - 72岁）。Harris髋关节评分平均从术前的60分（范围为30 - 69分）提高到末次随访时的96分（范围为80 - 100分）。并发症包括1例患者出现股神经失用和深静脉血栓形成，二者均已缓解。1例髋关节在术后15个月因髋臼杯松动需要翻修。未观察到进行性透亮线、缺血性坏死或脱位。在3个髋关节中检测到异位骨化。我们系列中早期股骨未出现失败情况可能与仔细的患者选择和恰当的手术技术有关。仰卧位经前外侧Watson-Jones入路能提供髋臼和股骨近端的最佳暴露，但广泛的软组织松解总是必要的。我们保留后外侧颈囊以提高维持股骨颈血供的几率，即使在前外侧和后外侧入路之间临床结果和并发症无明显差异。
