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[全髋关节置换的微创前外侧入路手术技术:视频文章]

[The minimally invasive AMIS technique for total hip replacement : Video article].

作者信息

Gollwitzer Hans

机构信息

ECOM® Excellent Center of Medicine, Arabellastr. 17, 81925, München, Deutschland.

出版信息

Orthopade. 2018 Sep;47(9):782-787. doi: 10.1007/s00132-018-3591-y.

DOI:10.1007/s00132-018-3591-y
PMID:29974162
Abstract

OBJECTIVE OF THE SURGERY

Minimally-invasive implantation of a total hip arthroplasty without damage to or incision of muscles.

INDICATIONS

Osteoarthritis, femoral neck fracture, general indications for total hip arthroplasty.

CONTRAINDICATIONS

Contraindications for hip arthroplasty.

SURGICAL TECHNIQUE

The surgical technique is demonstrated in detail with the help of a video of the surgical procedure, which is available online: positioning on a fracture table with a special leg holder, anterior approach between tensor fasciae latae and rectus femoris muscle, incision of hip capsule and capsular protection, osteotomy of femoral neck in situ, removal of femoral head and acetabular reaming, minimally invasive implantation of acetabular cup, release of pubofemoral ligament and-if necessary-ischiofemoral ligament, external rotation and hyperextension in leg holder with elevation of the proximal femur by a hypomochlion, femoral preparation and implantation of femoral implant, reposition, capsular suture, wound closure.

FOLLOW-UP: Weight-bearing as tolerated, free movement without limitation of range of motion.

EVIDENCE

Randomized trials and systematic reviews report faster rehabilitation with early mobilization, within the first 3 months after surgery; less postoperative pain, less muscle damage and shorter hospital stay; older patients benefit from reduced morbidity and mortality.

摘要

手术目的

微创植入全髋关节置换假体,不损伤或切开肌肉。

适应症

骨关节炎、股骨颈骨折、全髋关节置换的一般适应症。

禁忌症

髋关节置换的禁忌症。

手术技术

借助手术过程视频详细展示手术技术,该视频可在线获取:使用特殊腿部固定器在骨折手术台上定位,在阔筋膜张肌和股直肌之间采用前路入路,切开髋关节囊并保护关节囊,原位股骨颈截骨,取出股骨头并进行髋臼扩髓,微创植入髋臼杯,松解耻骨股韧带以及必要时的松解坐骨股韧带,在腿部固定器中进行外旋和过伸,通过吊床抬高股骨近端,准备股骨并植入股骨假体,复位,缝合关节囊,关闭伤口。

随访

根据耐受情况负重,自由活动且不受运动范围限制。

证据

随机试验和系统评价报告显示,术后早期(术后前3个月内)进行活动可实现更快康复;术后疼痛减轻、肌肉损伤减少且住院时间缩短;老年患者受益于发病率和死亡率的降低。

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Orthopade. 2018 Sep;47(9):782-787. doi: 10.1007/s00132-018-3591-y.
2
[Minimally invasive anterolateral approach for total hip replacement (OCM technique)].[全髋关节置换的微创前外侧入路(OCM技术)]
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[Treatment of femoroacetabular impingement using a minimally invasive anterior approach].[采用微创前路入路治疗股骨髋臼撞击症]
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J Exp Orthop. 2024 Oct 30;11(4):e70066. doi: 10.1002/jeo2.70066. eCollection 2024 Oct.
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[Fast-Track-Arthroplasty].[快速通道关节成形术]
Orthopadie (Heidelb). 2024 Feb;53(2):117-126. doi: 10.1007/s00132-023-04465-4. Epub 2024 Jan 16.
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[Perioperative management in fast-track arthroplasty].[快速通道关节置换术的围手术期管理]

本文引用的文献

1
Does Surgical Approach Affect Outcomes in Total Hip Arthroplasty Through 90 Days of Follow-Up? A Systematic Review With Meta-Analysis.手术入路是否通过 90 天随访影响全髋关节置换术的结局?系统评价与荟萃分析。
J Arthroplasty. 2018 Apr;33(4):1296-1302. doi: 10.1016/j.arth.2017.11.011. Epub 2017 Nov 14.
2
OBTAIN A: Outcome Benefits of Tranexamic Acid in Hip Arthroplasty. A Randomized Double-Blinded Controlled Trial.氨甲环酸在髋关节置换术中的疗效益处:一项随机双盲对照试验
J Arthroplasty. 2017 May;32(5):1516-1519. doi: 10.1016/j.arth.2016.11.045. Epub 2016 Dec 8.
3
[Revision arthroplasty of the hip : Direct anterior approach].
Orthopade. 2022 May;51(5):366-373. doi: 10.1007/s00132-022-04244-7. Epub 2022 Apr 12.
4
[Avulsion injuries of the gluteus medius and gluteus minimus muscles].[臀中肌和臀小肌撕脱伤]
Unfallchirurg. 2021 Jul;124(7):526-535. doi: 10.1007/s00113-021-01034-2. Epub 2021 Jun 25.
5
[Fast track in hip and knee arthroplasty].[髋关节和膝关节置换术的快速康复]
Orthopade. 2021 Apr;50(4):333-343. doi: 10.1007/s00132-021-04071-2. Epub 2021 Feb 26.
[髋关节翻修置换术:直接前路入路]
Orthopade. 2017 Feb;46(2):121-125. doi: 10.1007/s00132-016-3376-0.
4
[Biological downsizing : Acetabular defect reconstruction in revision total hip arthroplasty].[生物缩尺法:翻修全髋关节置换术中髋臼缺损的重建]
Orthopade. 2017 Feb;46(2):158-167. doi: 10.1007/s00132-016-3379-x.
5
[Treatment of acetabular bone defects in revision hip arthroplasty using the Revisio-System].[使用Revisio系统治疗髋关节翻修术中的髋臼骨缺损]
Orthopade. 2017 Feb;46(2):126-132. doi: 10.1007/s00132-016-3375-1.
6
[Surgical access routes to the hip joint in the elderly].[老年人髋关节的手术入路]
Orthopade. 2017 Jan;46(1):18-24. doi: 10.1007/s00132-016-3366-2.
7
Total Hip Arthroplasty Performed Through Direct Anterior Approach Provides Superior Early Outcome: Results of a Randomized, Prospective Study.经直接前路行全髋关节置换术具有更优的早期疗效:一项随机前瞻性研究的结果
Orthop Clin North Am. 2016 Jul;47(3):497-504. doi: 10.1016/j.ocl.2016.03.003.
8
The Wuerzburg procedure: the tensor fasciae latae perforator is a reliable anatomical landmark to clearly identify the Hueter interval when using the minimally-invasive direct anterior approach to the hip joint.维尔茨堡手术方法:在采用髋关节微创直接前路入路时,阔筋膜张肌穿支是明确识别休特间隙的可靠解剖标志。
BMC Musculoskelet Disord. 2016 Feb 3;17:57. doi: 10.1186/s12891-016-0908-z.
9
Comparison of Direct Anterior and Lateral Approaches in Total Hip Arthroplasty: A Systematic Review and Meta-Analysis (PRISMA).全髋关节置换术中直接前路与外侧入路的比较:系统评价与Meta分析(PRISMA)
Medicine (Baltimore). 2015 Dec;94(50):e2126. doi: 10.1097/MD.0000000000002126.
10
Comparison of Patient Function during the First Six Weeks after Direct Anterior or Posterior Total Hip Arthroplasty (THA): A Randomized Study.直接前路或后路全髋关节置换术(THA)后前六周患者功能的比较:一项随机研究。
J Arthroplasty. 2015 Sep;30(9 Suppl):94-7. doi: 10.1016/j.arth.2014.12.038. Epub 2015 Jun 3.