最新OCM入路小切口全髋关节置换教学讲义PPT

THA
Open surgery for synovial chondromatosis
Bone grafting in AVN
Surgery for femoral acetabular impingement (FAI)
Bone&Joint Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School
• 缺点：伤臀肌及外旋肌肉，并非真正意义微创，后脱位风 险高。
Bone&Joint Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School
两切口入路two-incision approach
• Berger于2004年首先报道了两切口入路法, 这种手术方式需要一定的 特制手术工具。
• 第一个切口是长约5 cm 的前外侧切口, 用来切除股骨头和安放髋臼假 体; 第二个切口是后路切口, 用来进行股骨准备, 切口位置与股骨髓内 钉的切口类似。
• 该手术方式不需切断臀中肌和臀后外旋肌, 手术从肌肉间隙进入, 组织 损伤小，能保留关节囊，是真正意义上的微创THA 手术。
• 缺点：麻烦，常需要透视。
• Reported in 2004
Orthopädische Chirurgie (OCM), München • OCM approach ---The modified Watson-Jones
Bone&Joint Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School
OCM入路小wenku.baidu.com口全髋关节置换
Disclosures
• No financial disclosures
Bone&Joint Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School
Minimally invasive surgery for THA (MISTHA)
• 代表性的为微创直接前入路，微创前外侧入路，微创后侧 入路及后外侧入路，以及双切口入路。
• 前外侧（OCM）入路和前侧入路及双切口均不损伤肌肉 ，为真正意义的微创切口。
• 前侧入路和双切口的应用很少，报道至今但目前仍很少医 院采用。
• OCM目前在德国应用很广，国内少数医院应用。
Bone&Joint Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School
Watson-Jones 切口暴露髋关节方法
Bone&Joint Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School
- The OCM approach using in our department
Bone&Joint Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School
Minimal-invasiver anterolateraler Zugang in der Hüftendoprothetik
• 不伤肌肉，且在神经肌肉界面进行， • 缺点：股骨操作困难。
Bone&Joint Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School
后侧微创小切口
• 后侧切口是一个改良Gibson切口。患者侧卧位, 骨盆固定, 以大转子后侧顶点为中心, 自后上向前下, 做一长约8~ 10 cm 的切口。
MIS-THA in China
• 微创的定义不清，真正微创应该是不损伤肌肉， 并非仅仅切口小，目前较为公认的为前侧、OCM 及双切口
• 国内应用较少的原因
– learning curve – Lack of knowledge and tools – Inconvinient on the early stage of learning – The long-term follow up showed similar results in
lateral aspect of the hip joint
Bone&Joint Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School
Watson-Jones入路介绍
OCM入路 Watson-Jones 入路
• Well fixed components • Stable joint • Impingement free ROM • Equal leg length
prothesis surviving despite of the better function achieved
Bone&Joint Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School
The aim for THA
前侧入路 前外侧入路及后侧入路解剖
Bone&Joint Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School
前侧入路
• 是一个改良的Smith-Peterson入路。以股骨大转子为界( 2 /3在上方, 1 /3 在下方), 平行于髂前上棘与腓骨头的连线后 方2 cm 为切口方向, 切口长度限于5~ 10 cm。