侧卧位直前入路内固定取出并行全髋关节置换

Implant removal and total hip arthroplasty in lateral position through direct anterior approach

摘要:

[目的] 介绍侧卧位直接前入路内固定并在同一切口行全髋关节置换的手术技术和初步临床结果。[方法] 对 2023 年本院收治的 1 例左侧股骨颈骨折切开复位内固定术后骨不连患者通过人工智能术前规划进行手术设计。患者取侧卧位，使用同一个前侧切口，经大腿前纵切口暴露股骨颈，取出螺钉钢板，截骨取股骨头，根据术前设计选定并置入髋臼杯与陶瓷内衬， 完成股骨扩髓并置入陶瓷短头。检查无脱位，最后冲洗缝合。[结果] 患者顺利完成手术，手术时间 135 min，术中出血量约 240 mL，术后第 1 d X 线片及 CT 示人工髋关节在位，关节间隙未见明显增宽或狭窄。术后第 3 d 患者可自行下地行走。术后 2 个月 Harris 评分 94.3 分，患髋活动度：屈曲 110°、外展 20°、外旋 10°、内收 10°，髋关节正侧位 X 线片示人工髋关节在位， 局部骨质未见硬化。[结论]同一直接前侧入路切口进行内固定螺丝取出和全髋关节置换创伤小，安全且有效，能够加速术后早期康复。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of implants removal and total hip arthroplasty in lateral position through direct anterior approach (DAA). [Methods] A patient who suffered from bone nonunion after open reduction and internal fixation of the left femoral neck fracture admitted to our hospital in 2023 underwent abovesaid surgical treatment after artificial intelligence preoperative planning. The patient was placed in lateral position, the DAA incision was used to expose the femoral neck. After the previous screws and plate were removed, the femoral head was extracted by osteotomy. As the acetabulum and proximal femoral medullary cavity were prepared, the acetabular cup and ceramic lining, as well as femoral stem and ceramic short head components selected according to the preoperative design were placed sequentially. Checking prosthetic components in proper position and no dislocation in motion, the wound was irrigated and closed in layers. [Results] The patient had operation perfored successfully with operation time of 135 min and intraoperative blood loss about 240 mL. The X-ray and CT showed that the prosthetic components was in place, without significantly widened or narrowed joint space 1 day postoperatively. The patient resumed walking independently 3 days after surgery, were marked Harris score of 94.3, with the affected hip range of motion of 110° in flexion, 20° in abduction, 10° in external rotation, and 10° in adduction 2 months after operation. The anterolateral and lateral radiographs of the affected hip showed the prosthetic components in good position, no local bone sclerosis observed. [Conclusion] The direct anterior approach used for implant removal and total hip arthroplasty in same stage is less invasive, safe and effective, and does accelerate early postoperative recovery.