侧卧位直接前路全髋关节置换手术技术

直接前路是理想的髋关节微创手术入路,特征是通过神经肌肉间隙显露髋关节。与其他入路相比,直接前路髋关节置换术具有术后疼痛轻、功能恢复快和患者满意度高等优势。然而,直接前路髋关节置换存在明显的学习曲线和较高的围手术期并发症。将患者体位由经典的仰卧位转换为侧卧位,旨在秉承直接前路的优点且克服仰卧位直接前路髋关节置换术中股骨侧显露困难的难题。侧卧位时髋关节后伸、外旋和内收程度较仰卧位明显增加,可以更加安全有效地完成股骨髓腔扩髓和股骨假体的精确植入。侧卧位直接前路髋关节置换术中髋臼视角与熟知的后方入路一样,术者无需改变髋臼侧操作习惯。熟悉直接前路解剖和理解技术难点是直接前路髋关节置换手术成功的关键。

Surgical technique of direct anterior approach for total hip arthroplasty in the lateral decubitus position

The direct anterior approach is an ideal minimally invasive surgical procedure,which exposes the hip joint through an intermuscular and internervous interval.Compared with other approaches,the direct anterior approach for total hip arthroplasty has several advantages,including less postoperative pain,faster functional recovery and higher patient satisfaction.However,the direct anterior approach could be associated with longer learning curve and higher rate of perioperative complications.We converted the operative position from the classic supine to the lateral decubitus position,aiming to inherit the advantages of the direct anterior approach and to overcome the difficulty of exposing the femoral side in the supine position.The degree of extension,external rotation and adduction of the hip joint was significantly increased in the lateral decubitus position compared to those in the supine position,which provided safe reaming of the femoral medullary cavity and precise implantation of the femoral stem.Therefore,the surgeons do not need to change the operating habits of the acetabular side.The reason is that the exposure of acetabulum in the lateral decubitus position is the same as that in familiar posterior approach.Familiarity with the surgical anatomy and understanding the limitations of the anterior hip approach are the key factors for successful execution.