Gollwitzer Hans
ECOM® Excellent Center of Medicine, Arabellastr. 17, 81925, München, Deutschland.
Orthopade. 2018 Sep;47(9):782-787. doi: 10.1007/s00132-018-3591-y.
Minimally-invasive implantation of a total hip arthroplasty without damage to or incision of muscles.
Osteoarthritis, femoral neck fracture, general indications for total hip arthroplasty.
Contraindications for hip arthroplasty.
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.
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.
微创植入全髋关节置换假体,不损伤或切开肌肉。
骨关节炎、股骨颈骨折、全髋关节置换的一般适应症。
髋关节置换的禁忌症。
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。
根据耐受情况负重,自由活动且不受运动范围限制。
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。