医学OCM入路小切口全髋关节置换专题课件.ppt
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1、Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolOCMOCM入路小切口全髋关节置入路小切口全髋关节置换换Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&
2、Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolDisclosures No financial disclosuresBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolMi
3、nimally invasive surgery for THA(MIS-THA)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 SchoolBone&Joint Center,The Affiliated Drum To
4、wer Hospital of Nanjing University Medical School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 SchoolBone&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
5、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。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 SchoolBone&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
6、8 10 cm 的切口。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 SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical School两切口入路two-incision approachBerger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
7、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。Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical S
8、choolMinimal-invasiver anterolateraler Zugang in der HftendoprothetikReported in 2004Orthopdische Chirurgie(OCM),MOrthopdische Chirurgie(OCM),M nchennchenOCM approach-The modified Watson-JonesBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,T
9、he Affiliated Drum Tower Hospital of Nanjing University Medical Schoollateral aspect of the hip jointBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolWatson-Jones入路介绍Watso
10、n-Jones 入路OCM入路入路Watson-Jones 切口暴露髋关节方法切口暴露髋关节方法Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolThe OCM approach using in our department-Bone grafting in AVNSurgery for f
11、emoral acetabular impingement(FAI)Open surgery for synovial chondromatosis THABone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolMIS-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
12、,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 curveLack of knowledge and toolsInconvinient on the early stage of learning The long-term follow up showed similar results in prothesis surviving despite of the better function achieved Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Me
13、dical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolThe aim for THAWell fixed componentsStable jointImpingement free ROMEqual leg lengthBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affi
14、liated Drum Tower Hospital of Nanjing University Medical SchoolPlan for MIS-THABMI髋关节活动度评估有无固定畸形原手术切口评估功能评分:Harris评分假体准备:臼杯无特殊股骨柄:选择解剖柄(SL-Plus MIA,Acorade Stem,短柄,etc)髋臼及股骨柄大小型号评估模板估计!模板估计!Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The
15、 Affiliated Drum Tower Hospital of Nanjing University Medical School适应症Fracture AVNOADDH?AS?Revision?手术技术成熟手术技术成熟Low BMI?High BMI?Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medica
16、l School小切口手术专用工具Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical School手术步骤介绍Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint
17、 Center,The Affiliated Drum Tower Hospital of Nanjing University Medical School体位侧卧位,手术床保持水平,避免影响外展角注意床水平不等于骨盆为侧位,可触摸髂前上棘大致判断也可以透视定位标准侧位侧卧位手术经验很关键!Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing
18、University Medical School入路标记1/43/4Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolOCM入路髋关节暴露间隙要找对皮肤切开暴露髂胫束暴露髂胫束Bone&Joint Center,The Affiliated Drum Tower Hospital of Na
19、njing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolOCM入路髋关节暴露髂胫束切开暴露关节囊Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing Univers
20、ity Medical School关节囊切除也可U形切开后翻瓣,术后予以修补,Really necessary?Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical School脱位一步截骨法对于部分先髋或股骨头坏死病例(股骨头较小)可以采用,小心臀中肌损伤。45Bone&Joint Center,The
21、Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical School两步截骨法第一刀紧贴股骨头下,截完后外旋后伸内收下肢,触摸小粗隆后行第二刀截骨,截骨位置与传统手术位置相同,取头器取出,股骨头直径较大时需要注意12Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing Univer
22、sity Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical School髋臼拉钩暴露处理髋臼处理与传统方式无差异,切除前外侧关节囊,去除盂唇、骨赘等Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing U
23、niversity Medical School髋臼磨锉Be careful of the glutei弯头锉进行髋臼处理,大头的髋臼处理可以用专用锉。注意外展角度可能和外侧入路感觉会不一样。Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical School安装试模Bone&Joint Center,The
24、Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical School可能的撞击骨赘清除Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Ho
25、spital of Nanjing University Medical School安装臼杯犬腿式安装器进行臼杯安装,再放入内衬Bone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical SchoolBone&Joint Center,The Affiliated Drum Tower Hospital of Nanjing University Medical School股骨侧处理Bone&Joint Center,The Affiliated Drum Tower Hospital
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- 医学 OCM 入路小 切口 髋关节 置换 专题 课件
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