小切口在全髋关节置换术中的应用

Mini-incision for total hip replacement

目的:探讨小切口下全髋关节置换术的方法和手术效果。方法:采用小切口下全髋关节置换术,临床应用12例15髋,股骨颈骨折7例7髋,股骨头缺血性坏死5例8髋。其中骨水泥型8髋,切口长度9～13cm,平均(11.8±1.2)cm;无骨水泥型7髋,切口长度7～9cm,平均(8.0±0.9)cm。结果:手术均在术前设计切口下顺利进行,术中无需对周围组织过分牵拉;术后有效随访4～9个月,平均7.6个月,切口一期甲级愈合,X线检查示假体位置良好。除1例患者(双髋)术后2周出现左下肢深静脉血栓形成经治疗痊愈外,其他患者无术后并发症。结论:在术前准备充分、解剖入路熟悉的前提下,采用小切口进行全髋关节置换确实可行,且有创伤小、愈合快、瘢痕小、外形美观等优点,是值得提倡的一种手术方法。

Objective:To investigate the surgical methods and clinical results of the mini-incision total hip replacement.Methods:From June2002to January2003,mini-incision total hip replacement was performed in12cases(15hips).Of these cases,12were males and8were females;from42.5to72.3kilogram,with the average of58.2kilogram;aged for an average of58.8years old(inrange of43to76years old).7cases(7hips were fracture of the femoral neck,5cases(8hips)were ischemic necrosis of the femoral head.8hips were performed with cement total hip replacement.The mean length of incision was11.8±1.2centimeters,from9to13centimeters:7hips were performed with cementless total hip replacement,and the mean length of incision was8.0±0.9centimeters,from7to9centimeters.Results:Operations were performed successfully using mini-incision and needn't drag soft tissue strongly.The mean followup was7.6months,ranging from4to9months.Primary healing was obtained in all cases,and the positions of the prosthesis were satisfactory.Of these cases,one developed deep-vein thrombosis of left lower limb after two weeks of operation and healed soon,others did not develop complication.Conclusion:With sufficient preopertive preparation and grasping the approaches accurately,the mini-incision total replacement possessing advantages of less damage,healed rapidly,small scar and beautiful outˉlook,is a good surgical method.