OCM入路微创全髋关节置换术的初步报告

目的介绍OCM入路微创全髋关节置换术(THA)的手术方法。方法2005年1月-2006年1月在对2具尸体、4个髋关节的OCM入路进行相关解剖学研究的基础上开展OCM入路微创THA 20例。手术从臀中肌前间隙进入切开关节囊,分段完成股骨颈截骨,使用特殊的髋臼锉和髋臼打入器安放髋臼假体;股骨侧手术时手术床后下方一半拆卸掉,患髋后伸和外旋且小腿置于消毒袋内,大转子周围关节囊广泛剥离后完成扩髓和股骨假体的安放。结果肥胖指数平均为27．4％的20例患者,皮肤切口长度平均为9．3 cm;术中平均出血130 mL,术后引流量80 mL;患者术后2-3 d下地活动。所有患者获得1-9个月(平均4．3个月)随访,15例已完全脱拐,行走正常;5例不满1个月,仍需扶拐行走。术后随访疼痛采用视觉模拟评分(VAS)由术前平均5．1分分别下降到3．6分(1个月)、1．7分(3个月)和0．8分(6个月)。发生血肿2例,X线检查见髋臼前倾过大2例,股骨假体型号偏小2例。患者髋关节功能Harris评分由术前平均45．4分提高到术后随访时平均88．4分。结论OCM入路微创THA切口小,完整保留臀中肌和关节囊,患者功能恢复快,住院时间短;它需要一个独立学习过程,并需要特殊器械的配合。

Total hip arthroplasty by the technique of OCM

Objective To introduce the technique of OCM hospital (Orthopadische Chirurgie Munchen) in total hip arthroplasty (THA). Methods From January 2005 to January 2006, 20 cases of THA were done in our department with the technique of OCM hospital. The operative approach was through the anterior interval of gluteus medius, and a "V" shaped capsulatomy and a twice-osteotomy of femoral neck were conducted. Specialized acetabular saws and positioners of cup were applied to fix the prosthesis and a table was used to allow the posterior part to be removed. The affected femur was then further externally rotated so that the lower extremity could be placed in the sterilized bag beside the table. In order to achieve better position of the femoral stem, an extensive capsule release was done. Results BMI (body mass index) averaged 27. 4% , the length of skin incision 9. 3 cm, and blood transfusion two units for all the patients. The blood loss and the drainage were 130 mL and 80 mL respectively. In the mean follow up of 4. 3 months, 15 cases recovered completely but five still needed crutches. The mean VAS (visual analog scale) evaluation decreased from the preoperative 5. 1 to 3. 6 (one month later), 1. 7 (three months later ) and 0. 8 (six months later). The mean Harris scores of hip for all the cases increased from the 45. 4 to 88. 4 postoperatively. Conclusions OCM THA owns many advantages, such as small skin incision, less injury to gluteus medius and rapid recovery of patients, but compared with a conventional THA it needs a long learning and special instruments. Its indications are patients who are not over-weighted and have their first THA. Therefore, it is suggested that only qualified hospital and surgeons are allowed to perform the operation.