髋关节课程03 手术显露和关闭伤口.PPTVIP

* * * * 我尝试前外侧或者外侧入路是在熟悉后外侧入路一年后，后外侧脱位率高，有报道达到10％，在翻修病人更高。对于一些后外侧入路晚期脱位的病人，脱过一次后在后方假性关节囊形成一滑膜疝气，容易复发。 * * * * * * * * * * * * * * * 除了类似的禁忌症外，最大的禁忌症是：经验。死体经验很重要，胖不行，有些人提出既往有手术史截骨， DDH,强直，异位骨化等都不行 * 小切口（微创） 相对禁忌症？ THA切口的关闭 引流管的使用 不使用引流管 使用引流管，自然引流----出血较多 使用引流管，引流憋1-2小时 引流拔出时间： 关节囊的缝合 薇乔1号线：连续？间断？ 致谢： 本文手术入路插图引自 Stanley Hoppenfeld, Piet deBoer, eds SURGICAL EXPOSURES IN ORTHOPAEDICS * * * Historically, when we talk about the posterior approach, vonLangenbeck first had an article in 1878 and Kocher in 1907. These two articles in the German literature really were the basis of the Kocher-Langenbeck approach. You will hear that term thrown around quite often. ? In the United States, the first documentation of a posterior approach was Ober in 1924. Actually, the surgery was done in the prone position and the incision was from the posterior inferior iliac spine. We are really posterior and really inferior down to the greater trochanter. As for irrigation and debridement of the septic hip and posterior wall acetabular fractures, Osborne had a variation in 1930, Caldwell in 1943, Horowitz [in 1952], and Henry [in 1960]. All these were direct posterior approaches. ? You will hear a lot about the Moore or “southern exposure” that was first written in 1957. It was a modification of Kocher’s approach. A patient was done in the standard lateral decubitus position that we do today. If you notice, the incision starts 10 cm distal to the posterosuperior iliac spine (PSIS) extending lateral to the greater trochanter and then distal along the femoral shaft. The problem [with the approach] was that it was not suitable for acetabular work. This is commented on in textbooks by Aufranc and Eftekhar. * * * * * * * * * * * * * 我尝试前外侧或者外侧入路是在熟悉后外侧入路一年后，后外侧脱位率高，有报道达到10％，在翻修病人更高。对于一些后外侧入路晚期脱位的病人，脱过一次后在后方假性关节囊形成一滑膜疝气，容易复发。 Kocher是一个普通外科医生。McFarland医生将外展肌肉包括臀中小肌完全从大粗隆剥离下来。 * * * * * * * * * * * Some of the criticism was that the direct lateral approach had an increased incidence of posto