63例人工髋关节置换手术的治疗体会(1)
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[摘要] 目的 总结实施人工髋关节置换手术后的治疗经验。 方法 回顾性分析2008年1月～2011年3月实施的63例人工髋关节置换手术的手术过程及术后体位与功能恢复的情况。 结果 本组63例无感染、脱位及假体松动病例，术后90°屈膝位放置的患者的膝关节功能明显较外展中立位放置的患者恢复快。 结论 (1)手术选用何种切口应根据术者的熟练程度及手术操作的器械而定，对采用外侧切口者术中可适当减小假体的前倾角度，如采用后外侧切口则术中应适当加大假体的前倾角度，可减少术后假体脱位的发生。(2)术后将膝关节间断放置于90°屈膝位并早期进行功能锻炼，更有利于患者下肢功能的恢复。
[关键词] 髋关节置换；手术切口；前倾角；术后体位；功能恢复
[中图分类号] R687.4 [文献标识码] A [文章编号] 1674-4721(2012)04(a)-0028-03
The treatment experiences of implementation of artificial hip replacement surgery in 63 cases
LUO Weichu XIE Daoyuan LI Cuifang HUANG Xiaojun HUANG Baolin LIN Qingpei BAI Yangping
Department of Orthopaedics, Qingxin County People′s Hospital of Guangdong Province, Qingxin 511800, China
[Abstract] Objective To summarize the experiences of treatment after artificial hip replacement surgery. Methods The implementation of the 63 patients were retrospectively analyzed artificial hip replacement surgery operation process and the position and function of the recovery from January 2008 to March 2011. Results There were no postoperative infection, dislocation and prosthesis loosening occurred in all 63 cases, and patients with 90 degrees of knee flexion position had a better recovery of the knee joints function compared with those who taken the position of abduction and neutral after operation. Conclusion (1)The choosing of operative incision depends on proficiency and instruments, doctors should be appropriate to reduce the forward angle of prosthesis when patients get anterolateral incision, the method of patients with posterolateral incision is opposite, and this can cut the odds of postoperative dislocation. (2)Taking 90 degrees of knee flexion position intermittently after operation and doing functional exercise as early as possible is good for the functional recovery of patient′s lower limbs.
[Key words] Hip replacement; Operative incision; Forward angle; Postoperative position; Functional recovery
本院于2008年1月～2011年3月共施行人工髋关节置换术63例，已取得了一定的经验，现初步总结如下：
1 资料与方法
1.1 一般资料
本组63例，男26例，女37例；年龄16～91岁，平均68.1岁。按照病因分：股骨颈骨折46例，股骨头缺血性坏死14例，类风湿性关节炎3例；按照手术切口分：外侧切口手术52例，外后侧切口手术11例。
1.2 手术方法
1.2.1 髋关节外侧切口入路 患者取健侧卧位，手术取髋关节外侧弧形切口，长为 10～12 cm，切开皮肤、深筋膜，顺阔筋膜张肌与臀大肌间隙分离，纵形切开股外侧肌，将肌肉向两侧牵开，稍将患肢屈髋、屈膝并外旋，作骨膜下剥离，显露股骨近端及小转子，向上沿臀中肌前缘切开，将臀中肌与阔筋膜张肌分别向两侧牵开，显露出关节囊。将关节囊切除，于小转子上方1.0～1.5 cm处行股骨颈截骨，取出股骨头，外旋患肢，充分显露髋臼，如行全髋关节置换 ......
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