Khan Rashid M, Cooper Gillian, Hull Jonathan B
Department of Orthopaedics, Frimley Park Hospital,Camberley, Surrey, UK.
Hip Int. 2009 Oct-Dec;19(4):338-42. doi: 10.1177/112070000901900407.
Hip resurfacing arthroplasty has conventionally been undertaken through the posterior approach. There has been evidence in the recently published literature to suggest that the posterior approach may compromise the blood supply to the femoral head, by disruption of the posterolateral hip capsule. Ganz et al have proposed the trochanteric 'flip' osteotomy through a lateral approach, to permit surgical dislocation of the hip without damaging the blood supply. The disadvantages, however, are that early full weight bearing is not permitted and there is an incidence of trochanteric delayed or non-union, which may require further treatment. We describe a technique of hip resurfacing through a modified anterolateral approach preserving the posterolateral capsular blood supply. We describe our experience using this approach, and compare the results with our previously used Ganz trochanteric osteotomy. At a mean follow-up of two years, the outcome scores were not significantly different, and both groups had similar abductor strength. There were two cases of delayed union in the Ganz group, one of which required revision; there were no complications in the modified anterolateral group.
传统上，髋关节表面置换术是通过后路进行的。最近发表的文献中有证据表明，后路可能会因破坏髋关节后外侧关节囊而损害股骨头的血液供应。甘茨等人提出通过外侧入路进行转子“翻转”截骨术，以允许髋关节在不损害血供的情况下进行手术脱位。然而，缺点是不允许早期完全负重，并且存在转子延迟愈合或不愈合的发生率，这可能需要进一步治疗。我们描述了一种通过改良前外侧入路进行髋关节表面置换的技术，保留后外侧关节囊血供。我们描述了使用这种方法的经验，并将结果与我们之前使用的甘茨转子截骨术进行比较。平均随访两年时，结果评分无显著差异，两组的外展肌力量相似。甘茨组有2例延迟愈合，其中1例需要翻修；改良前外侧组无并发症。
