【摘要】： 目的自行設(shè)計髖部前側(cè)微創(chuàng)入路,介紹其在常見髖部疾患手術(shù)中的應(yīng)用,并探討臨床療效。 方法 1、解剖1具成年尸體標(biāo)本(2髖),尋求最佳的微創(chuàng)入路。 2、2006年1月～2008年4月采用設(shè)計的入路,對14例難復(fù)位的移位型股骨頸骨折患者行開放復(fù)位內(nèi)固定術(shù)(設(shè)為微創(chuàng)組)。將同期采用前外側(cè)入路治療的15例設(shè)為對照組。比較兩組的臨床療效。 3、同期采用設(shè)計的入路治療5例兒童股骨頭缺血性壞死(LCPD)患者、6例股骨近端病變患者、1例合并帕金森病的股骨頸骨折患者,觀察臨床療效。 結(jié)果 1、前側(cè)微創(chuàng)入路的切口定位于大腿上段1/8-1/4處,與大腿軸線夾角為20度,經(jīng)肌間隙進(jìn)入關(guān)節(jié)囊。 2、在股骨頸骨折的治療中,微創(chuàng)組的切口長度、術(shù)中出血量、手術(shù)時間、術(shù)后住院天數(shù)均小于對照組,差異有統(tǒng)計學(xué)意義(P＜0.05)。術(shù)后2月兩組的骨折愈合情況、并發(fā)癥發(fā)生率無差異。 3、前側(cè)微創(chuàng)入路在LCPD、股骨近端病變的手術(shù)診療中,切口小、出血少、手術(shù)時間短、無不良并發(fā)癥。 4、經(jīng)前側(cè)微創(chuàng)入路行雙極股骨頭置換治療合并帕金森病的股骨頸骨折患者。切口長度9.8cm、手術(shù)時間90min、術(shù)中出血350ml、術(shù)后發(fā)生對側(cè)股動脈栓塞。 5、在前三組中,切口長度、術(shù)中出血量、手術(shù)時間均隨著手術(shù)例數(shù)的增加呈下降趨勢。 結(jié)論 1、自行設(shè)計的髖前側(cè)微創(chuàng)入路可應(yīng)用于多種髖部疾患手術(shù),術(shù)中切口小、出血少、時間短、創(chuàng)傷小,術(shù)后患者康復(fù)快、滿意度高,初期觀察臨床療效好。 2、采用前側(cè)微創(chuàng)入路存在著學(xué)習(xí)曲線,對術(shù)者要求較高。
[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.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2008
【分類號】：R687.3;R322

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