髋部前侧微创入路的解剖学和初步临床应用研究

发布时间：2018-11-22 14:47

【摘要】： 目的自行设计髋部前侧微创入路,介绍其在常见髋部疾患手术中的应用,并探讨临床疗效。方法 1、解剖1具成年尸体标本(2髋),寻求最佳的微创入路。 2、2006年1月～2008年4月采用设计的入路,对14例难复位的移位型股骨颈骨折患者行开放复位内固定术(设为微创组)。将同期采用前外侧入路治疗的15例设为对照组。比较两组的临床疗效。 3、同期采用设计的入路治疗5例儿童股骨头缺血性坏死(LCPD)患者、6例股骨近端病变患者、1例合并帕金森病的股骨颈骨折患者,观察临床疗效。结果 1、前侧微创入路的切口定位于大腿上段1/8-1/4处,与大腿轴线夹角为20度,经肌间隙进入关节囊。 2、在股骨颈骨折的治疗中,微创组的切口长度、术中出血量、手术时间、术后住院天数均小于对照组,差异有统计学意义(P＜0.05)。术后2月两组的骨折愈合情况、并发症发生率无差异。 3、前侧微创入路在LCPD、股骨近端病变的手术诊疗中,切口小、出血少、手术时间短、无不良并发症。 4、经前侧微创入路行双极股骨头置换治疗合并帕金森病的股骨颈骨折患者。切口长度9.8cm、手术时间90min、术中出血350ml、术后发生对侧股动脉栓塞。 5、在前三组中,切口长度、术中出血量、手术时间均随着手术例数的增加呈下降趋势。结论 1、自行设计的髋前侧微创入路可应用于多种髋部疾患手术,术中切口小、出血少、时间短、创伤小,术后患者康复快、满意度高,初期观察临床疗效好。 2、采用前侧微创入路存在着学习曲线,对术者要求较高。
[Abstract]:Objective to design the anterior minimally invasive approach of hip, and to introduce its application in the operation of common hip diseases, and to discuss the clinical effect. Methods 1. The best minimally invasive approach was found by dissecting 1 adult cadaveric specimen (2 hips). From January 2006 to April 2008, 14 patients with displaced femoral neck fractures were treated with open reduction and internal fixation (minimally invasive group). Fifteen patients who were treated with anterolateral approach at the same time were set up as control group. To compare the clinical effect between the two groups. 3. At the same time, the designed approach was used to treat 5 children with avascular necrosis of femoral head (LCPD), 6 patients with proximal femoral lesions and 1 patient with femoral neck fracture complicated with Parkinson's disease. Results 1. The anterior minimally invasive approach was located at 1 / 8 / 1 / 4 of the upper thigh, with an angle of 20 degrees to the axis of the thigh, and entered the joint capsule through the muscle space. 2. In the treatment of femoral neck fracture, the length of incision, the amount of intraoperative bleeding, the time of operation and the days of hospitalization after operation in the minimally invasive group were smaller than those in the control group (P < 0.05). Two months after operation, there was no difference in the incidence of complications between the two groups. 3. The anterior minimally invasive approach in the diagnosis and treatment of proximal femoral lesions of LCPD, has the advantages of small incision, less bleeding, short operation time and no adverse complications. 4. Bipolar femoral head replacement via anterior minimally invasive approach was used to treat femoral neck fracture with Parkinson's disease. The length of incision was 9.8 cm, the operative time was 90 min, the bleeding was 350 ml, and the embolization of contralateral femoral artery occurred after operation. 5. In the first three groups, the length of incision, the amount of intraoperative bleeding and the time of operation decreased with the increase of the number of cases. Conclusion 1. The self-designed anterior minimally invasive approach can be used in the operation of multiple hip diseases with small incision, less bleeding, short time, less trauma, quick recovery, high satisfaction, and good clinical effect at the initial stage. 2. There is a learning curve in the anterior minimally invasive approach.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R687.3;R322

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