小切口全髋关节置换术治疗髋臼发育不良的临床研究

目的探讨前外侧小切口入路全髋关节置换治疗髋臼发育不良的可行性。方法2004年2月-2008年1月,采用前外侧小切口对30例髋臼发育不良的患者行全髋关节置换术,记录切口长度、出血量、手术时间、术后功能恢复及并发症。结果手术切口长度平均8cm（7—10cm）,手术时间平均80min（70-120min）,出血量平均约300ml（250～660ml）,无严重并发症发生,术后7d负重行走,Harris评分平均92分,优良率93．9％。结论小切口全髋关节置换可选择治疗部分髋臼发育不良患者,具有创伤小、出血少、恢复快等优点。     

小切口全髋关节置换术

目的　探讨侧前方小切口入路全髋关节置换术的可行性。　方法　2003年2月~2003年12月,采用前外侧小切口对53例58个髋关节行全髋置换术,其中5例为双侧同时手术, 6例全髋关节翻修手术, 4例关节完全强直的置换术。改良要点:平卧位,患侧半边臀部略悬空于手术床边,使臀大肌自然下垂,患侧下肢内收10°,使大粗隆突出部份充分暴露;股骨颈及大粗隆暴露后,先截骨,再脱位取出股骨头。　结果　手术切口长度7~12cm,平均8 5cm。手术时间70 ~140min,平均88min。出血量250~660ml,平均470ml。无严重并发症。术后6~14d部分负重行走。全部病例获得4~40周随访,平均28周,Harris评分优37例,良12例,中4例,优良率达92 .5% (49 /53)。　结论　侧前方小切口全髋关节置换术可行,具有创伤小、出血少、恢复快等优点,其应用范围可扩展到人工髋关节翻修、髋关节强直、髋关节先天脱位的人工全髋关节置换手术中。     

小切口人工全髋关节置换术

目的 :初步探讨小切口人工全髋关节置换术的优越性。方法 :比较了 9例小切口人工全髋关节置换术与传统人工全髋关节置换术在切口长度、术中出血量、术后引流、手术时间、术后疼痛、住院天数、住院费用、早期活动、并发症、Harri评分方面的不同。结果 :发现在相同条件下 ,小切口手术明显减少了术中出血、术后疼痛、住院天数、住院费用 ,促进了早期活动 ,并且对手术的效果无影响。结论 :小切口在人工全髋关节置换术中是可行的     

前路小切口人工全髋关节置换术疗效分析

目的对前路小切口人工髋关节置换术(THA)的临床效果进行回顾分析。方法将2002年8月至2004年2月施行THA的120例患者随机分成两组,每组60例患者,分别采用前路小切口和传统后路切口,对手术时间、出血量、并发症、切口长度、术后平均住院时间、术后Harris评分进行比较。结果平均随访20个月(12～30个月)。小切口组的平均手术时间为72min,传统切口组为69min(P>0.05);小切口组的平均切口长度为7.9cm,传统切口组为16.3cm(P<0.01);小切口组出血量平均为350ml,传统切口组650ml(P<0.01);小切口组平均术后住院时间为7d,传统切口组为13.5d(P<0.05)。小切口组术后X线片髋臼前倾角平均为24°,传统切口组为19°;小切口组外展角平均为47°,传统切口组为45°。术后3个月随访时,小切口组的平均Harris评分为91.4分,传统切口组为78.5分(P<0.05);末次随访时,小切口组的平均Harris评分为95.1分,传统切口组为95.6分(P>0.05),但两组髋关节活动度差异有统计学意义,分别为(110.0±3.2)°和(90.0±2.9)°(P<0.05)。两组患者都未出现感染、血管神经损伤等并发症。小切口组有1例术中摄片发现髋臼前倾角偏大,立即将髋臼取出重新安放,术后无不良反应。传统切口组2例症状性DVT,1例出现嗜睡,CT示脑基底节小梗塞灶。结论前路小切口THA具有创伤小、出血少、美观的优点,是一种安全、有效、可靠的方法。     

不同材料假体人工全髋关节置换效果的临床观察

[目的]研究不同材料假体对人工全髋关节置换近期临床效果的影响.[方法]选取85例92髋人工全髋关节置换患者,通过X线影像资料,对不同材料髋关节假体对股骨近端、髋臼周围骨质的应力影响进行临床观察.[结果]各组均未发现髋臼及股骨假体松动的临床表现,髋臼及股骨假体周围的骨量无明显应力性骨吸收影像,金属-金属组、陶瓷-陶瓷组未发现有碎屑反应,陶瓷-聚乙烯组、金属-聚乙烯组部分有碎屑反应.[结论]使用不同材料假体组合并不会导致股骨假体、髋臼假体与骨界面应力的显著差别,其远期效果差别除了与假体的制作水平、患者的骨质条件及医生的手术技术等密切相关外,聚乙烯材料产生的磨损碎屑所致的骨溶解应该是最关键因素.     

后外侧入路微创小切口人工全髋关节置换术

[目的]探讨后外侧入路微创小切口人工全髋关节置换术(total híp arthroplasty,THA)的临床疗效.[方法]2005年6月～2008年12月,采用改良后外侧入路微创小切口人工全髋关节置换术治疗髋关节疾病患者31例33髋,均为单切口微创技术,并与同时期微创传统人工全髋关节置换术的28例31髋患者比较,两组患者年龄、性别、病种、体重指数、髋关节功能等大致相同.分析两组病例围手术期出血量、手术时间、切口长度、疼痛评分、Harris评分、假体位置、并发症等,并进行两组病例对比研究.[结果]小切口THA组与传统THA组病例随访6～48个月,平均24.8个月.两组手术时间相近.小切口组平均切口长度9.2 cm(7～11 cm),传统手术组15 cm(12～20cm),两组差异有统计学意义(P＜0.01);围手术期出血量小切口组450 ml(200 ～600 ml),传统组800 ml(600～1200 ml),两组有统计学意义(P＜0.05);小切口组疼痛评分5.1分,传统组为6.5分(P＜0.05);术后6个月小切口组Harris评分93.8分(85～99分);传统组92.1分(82～96分)(P＞0.05).小切口组术后早期功能恢复较传统组快,而中期结果相似.术后及随访时,两组假体位置均良好.两组THA均末出现术后脱位、感染.肢体不等长各2例,但差异均在1 cm以内,两组均各出现2例下肢深静脉血栓形成.[结论]小切口微创THA可选择性用于部分髋关节疾病的治疗,手术创伤小,围手术期出血少,切口小,疼痛轻,术后恢复快,且可获得与传统后路THA相同的治疗效果.     

微小切口行全髋置换手术操作及早期疗效

目的介绍经后外侧入路小切口行全髋成形术的手术操作并对术后早期疗效进行评估。方法采用小切口经后外侧入路行全髋置换术18例(21髋),术前术后髋关节功能评定按Harris评分。评估内容包括切口长度、手术持续时间、术中失血量、术中和术后并发症及手术效果。结果全部患者术后随访10~16个月,髋Harris评分均较术前提高,差异有显著性(P<0.05);切口平均长度为9.7 cm;平均手术时间88 m in;平均术中失血量509 m l;无伤口感染、骨折及血管神经损伤等并发症。随访时骨盆X线片未发现有假体松动、移位、断裂等迹象。大多患者1个月后无需持拐辅助行走。结论小切口行全髋置换术具有微创、康复快、并发症少、安全可靠等优点。     

小切口不保留关节囊的全髋关节置换术

目的探讨小切口人工全髋关节置换术(THA)中不保留关节囊的安全性和实用价值。方法回顾性分析本组1999年1月至2009年1月行初次THA的患者,其中采用小切口不保留关节囊的THA(A组)141例163髋,男61例,女80例,年龄26～95岁,平均66.5岁;同期采用小切口不保留关节囊且未缝合修补外旋肌的THA(B组)88例101髋,男41例,女47例,年龄44～75岁,平均61.5岁;同期采用传统Gibson切口,保留关节囊的并修复外旋肌群的THA(C组)72例84髋,男30例,女42例;年龄33～80岁,平均68.3岁。对三组患者的手术切口长度、手术时间、出血量、髋脱位率、Harris评分进行比较。结果三组患者均获至少6个月的随访,A、B组在切口长度、手术时间方面与C组间的差异有统计学意义(P0.05);三组之间出血量、髋脱位、术后6个月的Harris评分间的差异无统计学意义(P0.05)。结论小切口THA具有微创一些优点,术中不保留关节囊,降低了手术难度,术野暴露充分,有利于髋臼假体及内衬的安装,并能有效缩短手术时间,不增加术后假体脱位率,从近期的疗效来看是一种安全快捷的髋关节置换方法。     

髋部手术继发髋关节感染的二期全髋关节置换

 目的 探讨应用抗生素骨水泥间隔体二期全髋关节置换治疗髋部手术继发髋关节感染的疗效。方法 从2005年1月至2010年1月应用二期全髋关节置换连续治疗髋部手术继发髋关节感染患者6例,男2例,女4例;年龄43～68岁,平均(59.7±9.2)岁。股骨颈骨折行加压螺钉固定3例,股骨头坏死骨瓣移植1例,早期股骨头坏死行中心钻孔减压及局部介入治疗各1例。一期手术彻底清创,植入抗生素(万古霉素)骨水泥间隔体,感染控制后二期植入全髋关节假体。术后定期随访,常规复查红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP),摄髋关节正侧位X线片,采用Harris髋关节评分评估髋关节功能。结果 所有患者均获得随访,随访时间24～81个月,平均46个月。5例患者在一期清创后平均14周(12～18周)行二期全髋关节置换,1例患者在一期清创后7个月行二次清创及重新植入骨水泥间隔体,12周后行二期全髋关节置换。Harris髋关节评分从术前平均(35.6±3.3)分,间隔期平均(57.8±5.4)分,提高至末次随访平均(92.3±5.7)分,差异有统计学意义。1例患者于间隔期出现下肢深静脉血栓形成及左下肺栓塞。随访期间未出现感染复发及新发感染病例。结论 对继发于髋部手术的髋关节感染,应用抗生素骨水泥间隔体行二期全髋关节置换可以获得较满意的近中期疗效。     

改良后外侧小切口全髋关节置换手术技术

目的探讨后外侧入路行小切口全髋关节置换术的技术方法及注意事项。方法通过对207例后外侧入路小切口全髋关节置换术手术技术、方法进行总结，规范其手术技术操作和不同髋关节疾病手术注意事项。结果本手术方式各操作步骤规范、合理，术中显露充分、准确，手术切口长度平均（7.4±1.3）cm；手术时间（64.4±20.6）min（最短32min），术中出血量（365±154）ml，术后引流量（151±65）ml。随访时间6-26个月（平均11.8个月），随访期内X线未见假体位置不良。Harris评分术后较术前明显提高：术前（48.0±11.7）分，术后（85.0±7.6）分。结论后外侧小切口全髋关节置换术具有创伤小、切口美观、围手术期出血少、术中术后并发症少及术后早期功能恢复快的优点，通过规范的技术操作步骤和针对不同髋关节疾病注意事项的妥善处理，可以达到比传统方法更优异的近期疗效。     

Minimal incision total hip arthroplasty

Although debate regarding minimally invasive hip surgery is inconclusive, information published to date on the risks and benefits of small-incision approaches focuses the discussion on quality and outcomes. Small-incision surgical approaches include the posterior, anterolateral, direct anterior, and two-incision approach. Computer navigation assists in mapping hip replacement surgery. Obesity is a risk factor and has been found to increase complications. Patient education, pain management, and rehabilitation are important to recovery after minimal incision hip arthroplasty. Total hip replacement may be successfully achieved via smaller incisions, but functional improvement, discharge to home, patient satisfaction, and analgesic requirement may be similar regardless of the length of the incision.     

Minimal incision total hip joint arthroplasty

"Minimaly-invasive" total joint arthroplasty have been widely introduced to the orthopaedic community several years ago. The concept has received a great attention and has been greeted variably with enthusiasm, concern, and skepticism. Numerous meetings, scientific exibits, symposia and congreses has been taking place all around the world. Whether this represents the future of orthopaedic surgery or just a fad, the term "minimaly-invasive" or "minimaly-incision" are yet to be clear and establish. Our intention is to present 72 of first 100 cases of total hip arthroplasty performed by "minimaly-incision" surgery. In our opinion first results are positve and we intend to continue with this kind of surgery.     

改良Hardinge小切口髋关节置换术

目的探讨改良Hardinge小切口入路髋关节置换术的可行性。方法2005年7月-2006年3月，采用以大转子为中心改良Hardinge小切口对21例22个髋关节行髋关节置换术。12例13髋行全髋关节置换，9例行双极股骨头置换，均采用生物型假体。结果手术切口平均长7．6cm（6．0—9．0cm），手术时间平均76min（45-150min），术中出血量平均370ml（190—580m1）。无严重并发症。21例平均随访38周（22—53周），Hams评分优18例19髋，良3例，优良率100％。结论改良Hardinge小切口髋关节置换术对关节的稳定性影响小，手术显露清楚，安全可行。     

改良小切口在全髋关节置换术中的应用

目的探讨改良小切口在全髋关节置换术(THR)的临床应用。方法自2002年6月～2005年1月,采用改良小切口技术进行人工THR,临床应用59例,切口长度为6．5～12．0 cm,平均(9．2±0．8)cm。结果所有患者手术均在术前设计的切口下顺利完成,术中无需对周围组织过分牵拉。术后所有患者术后获得6～25个月(平均12．5个月)随访,X线检查示假体位置良好,无内外翻出现；除1例术后出现切口轻度脂肪液化经治疗痊愈外,其他患者无术后并发症；关节Harris评分从术前的平均32．5分提高至术后的平均91分。结论在术前准备充分、解剖入路熟悉的前提下,采用改良小切口技术进行人工THR确实可行,具有创伤小、愈合快、瘢痕小、外形美观等优点。     

Posterolateral minimal incision for total hip replacement: technique and early results

There presently exists in the arthroplasty community a new and heightened level of interest in minimally invasive techniques for total joint replacement. Several investigators have published their personal experience with differing techniques, all concluding that there are multiple advantages to this concept for total hip arthroplasty. The author's perception is that the advantages of minimally invasive posterolateral approach total hip arthroplasty are multiple. They include more rapid rehabilitation and more prompt return to activities of daily living. There has been a clear impression that patients experience less postoperative pain and improved satisfaction. A concomitant decrease in hospital stay has been noted. Patients undergoing the procedure today have an average length of hospital stay of 48 hours, which represents a 30% decrease in hospital stay over the last year. Other advantages include improved cosmesis and potentially reduced blood loss without increasing complication rates. Surgeons performing this procedure require familiarity with the local anatomy, because the technique is certainly more demanding than is traditional arthroplasty. It is perhaps a technique best applied by surgeons performing more than 50 total hip arthroplasties a year. The two keys to successful application of the technique are adequate surgical training and use of specialized instrumentation. It is a difficult procedure to teach, because only one person is able to access a good view of the anatomy at any one time. With respect to component positioning, there may be a tendency to vertical cup placement early in one's experience. This is avoided by proper location of the skin incision and by use of a dog legged acetabular component inserter that facilitates proper positioning of the component despite the prominence of the distal angle of the skin incision. A tendency to eccentric reaming of the acetabulum may be noted if the proximal femur is not adequately retracted anteriorly. One must beware of the potential for inadvertent levering of the acetabular reamers on the posterior aspect of there tracted femur if the operative surgeon is not performing the reaming of the acetabulum. Particularly in patients who are larger there may be a tendency toward an excessively posterior starting point in the femoral canal when broaching the femoral component. This is best avoided by careful attention at this portion of the procedure to any pressure being applied to the broach handle by the proximal corner of the skin incision. The skin incision must be lengthened at this point if the problem presents. Finally, there remains a risk for proximal skin abrasion, particularly when one is beginning to decrease, the incision length in posterolateral approach to total hip arthroplasty. The evolution of proximal femoral elevators and skin protectors has decreased this risk to an extremely low level.     

Minimal invasive surgery for hip replacement: a new technique using the NILNAV hip system

Background: Minimal invasive surgical techniques are used for cruciate ligament reconstructions, unicondylar knee replacements and, more recently, for fixation of fractures. This is a report of the first instrumented technique for hip replacement using a 5‐cm incision without the need for a navigation system or X‐rays. Methods: It uses the C.F.P stem (LINK) but is universal. It includes jigs for the osteotomy of the neck, a right‐angled reamer and spacers (lollipops) to orientate the acetabular cup to the femoral stem. A case series of 14 patients using this new hip replacement technique (called NILNAV Hip System) is reported. Results: The procedure was successfully performed on all seven patients, with reduced postoperative pain and stiffness, and increased quality of life and functional status. All patients were discharged on postoperative Days 1 and 2 with minimal pain and blood loss. Conclusions: This new minimal access total hip replacement technique was successfully performed on seven patients. There are several advantages of using this system compared with the more traditional techniques. Such a technique should help reduce morbidity and mortality rates for those patients undergoing a total hip replacement.     

Minimal incision congenital cardiac surgery

Minimally invasive techniques have had limited application in congenital cardiac surgery, primarily due to the complexity of the defects, small working area, and the fact that most defects require exposure to intracardiac structures. Advances in cannula design and instrumentation have allowed application of minimal incision techniques but in most cases, cardiopulmonary bypass is still required. Image guided surgery, which uses noninvasive imaging to guide intracardiac procedures, holds the promise of permitting performance of reconstructive surgery in the beating heart in children.