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全髋关节置换术中的前路手术改善了治疗效果:反对。

Anterior approach in THA improves outcomes: opposes.

作者信息

Sculco Thomas P

机构信息

Hospital for Special Surgery, New York, New York, USA.

出版信息

Orthopedics. 2011 Sep 9;34(9):e459-61. doi: 10.3928/01477447-20110714-29.

Abstract

Total hip arthroplasty (THA) can be performed through multiple surgical approaches, including anterior, anterolateral, lateral, transtrochanteric, posterolateral, posterior, and the 2-incision technique. The overwhelming majority of THAs today are performed through a posterolateral approach, which has many advantages: it can be extended without difficulty, it is expeditious, it results in reduced blood loss and little muscle damage, and recovery is rapid. The major disadvantage of the approach is its increased dislocation rate, which has become less of a problem with the advent of larger femoral heads and dual-mobility acetabular components. The anterior approach is another hip approach with advantages and disadvantages. One disadvantage is the need for a special table on which to perform the procedure, which can cost ≥$100,000. Many surgeons also recommend the use of intraoperative fluoroscopy with this approach, which prolongs surgery and adds possible draping contamination during the fluoroscopy. Exposure of the femur may be difficult with this approach, especially in patients with increased body mass index. The operative time also tends to be longer with this approach, as exposure may be more tedious. The published data report significant complications with this procedure.

摘要

全髋关节置换术(THA)可通过多种手术入路进行,包括前方、前外侧、外侧、经转子、后外侧、后方以及双切口技术。如今绝大多数的全髋关节置换术是通过后外侧入路进行的,该入路有诸多优点:可轻松延长切口,操作迅速,失血少且肌肉损伤小,恢复快。该入路的主要缺点是脱位率增加,不过随着更大股骨头和双动髋臼组件的出现,这一问题已不那么突出。前方入路是另一种有优缺点的髋关节入路。一个缺点是需要一张特殊的手术台来进行手术,这张手术台成本可能≥10万美元。许多外科医生还建议在此入路中使用术中透视,这会延长手术时间,并在透视过程中增加可能的铺巾污染。采用此入路时,股骨的暴露可能困难,尤其是在体重指数增加的患者中。此入路的手术时间往往也更长,因为暴露过程可能更繁琐。已发表的数据报道了该手术存在显著并发症。

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