Name: the transition to an anterior-based muscle sparing approach improves early postoperative function but is associated with a learning curve
Uploaded: 2022-09-07T12:30:00
Description: Watch this Scientific Journal Video about The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve at JoVE.com

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机构审查委员会批准了这项回顾性研究（IRB 00060819），该研究涉及去识别化的前瞻性收集数据。该协议遵循了基督复临安息日会健康洛迪纪念馆的联合国机构审查委员会批准的指导方针。手术前获得患者的书面知情同意。
注：作为代表性患者，描述了一名78岁男性左髋部疼痛的临床病程。他的症状包括 2 年左腹股沟疼痛因活动而加重、使用消炎药物无法充分缓解夜间疼痛以及...

<ol>
	<li>Melman, W. P., Mollen, B. P., Kollen, B. J., Verheyen, C. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=First+experiences+with+the+direct+anterior+approach+in+lateral+decubitus+position:+Learning+curve+and+1+year+complication+rate.">First experiences with the direct anterior approach in lateral decubitus position: Learning curve and 1 year complication rate.</a> Hip International. 25 (3), 251-257 (2015).</li><li>Rottinger, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+MIS+anterolateral+approach+for+THA.">The MIS anterolateral approach for THA.</a> Orthopade. 35 (7), 708-715 (2006).</li><li>Bertin, K. C., R&#246;ttinger, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anterolateral+mini-incision+hip+replacement+surgery:+A+modified+Watson-Jones+approach.">Anterolateral mini-incision hip replacement surgery: A modified Watson-Jones approach.</a> Clinical Orthopaedics and Related Research. 429, 248-255 (2004).</li><li>Civinini, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+anterior-based+muscle-sparing+approach+to+the+hip:+The+&amp;#34;other&amp;#34;+anterior+approach+to+the+hip.">The anterior-based muscle-sparing approach to the hip: The &amp;#34;other&amp;#34; anterior approach to the hip.</a> International Orthopaedics. 43 (1), 47-53 (2019).</li><li>De Geest, T., Fennema, P., Lenaerts, G., De Loore, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adverse+effects+associated+with+the+direct+anterior+approach+for+total+hip+arthroplasty:+A+Bayesian+meta-analysis.">Adverse effects associated with the direct anterior approach for total hip arthroplasty: A Bayesian meta-analysis.</a> Archives of Orthopaedic and Trauma Surgery. 135 (8), 1183-1192 (2015).</li><li>Christensen, C. P., Karthikeyan, T., Jacobs, C. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Greater+prevalence+of+wound+complications+requiring+reoperation+with+direct+anterior+approach+total+hip+arthroplasty.">Greater prevalence of wound complications requiring reoperation with direct anterior approach total hip arthroplasty.</a> The Journal of Arthroplasty. 29 (9), 1839-1841 (2014).</li><li>Leiberman, J. R., Berry, D. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Advanced Reconstruction: Hip 2. , (2018).</li><li>Delanois, R. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Rottinger+approach+for+total+hip+arthroplasty:+Technique,+comparison+to+the+direct+lateral+approach+and+review+of+literature.">The Rottinger approach for total hip arthroplasty: Technique, comparison to the direct lateral approach and review of literature.</a> Annals of Translational Medicine. 5, 31 (2017).</li><li>Martin, R., Clayson, P. E., Troussel, S., Fraser, B. P., Docquier, P. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anterolateral+minimally+invasive+total+hip+arthroplasty:+A+prospective+randomized+controlled+study+with+a+follow-up+of+1+year.">Anterolateral minimally invasive total hip arthroplasty: A prospective randomized controlled study with a follow-up of 1 year.</a> The Journal of Arthroplasty. 26 (8), 1362-1372 (2011).</li><li>Laffosse, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Learning+curve+for+a+modified+Watson-Jones+minimally+invasive+approach+in+primary+total+hip+replacement:+Analysis+of+complications+and+early+results+versus+the+standard-incision+posterior+approach.">Learning curve for a modified Watson-Jones minimally invasive approach in primary total hip replacement: Analysis of complications and early results versus the standard-incision posterior approach.</a> Acta Orthopaedica Belgica. 72 (6), 693 (2006).</li><li>Chen, D., Berger, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outpatient+minimally+invasive+total+hip+arthroplasty+via+a+modified+Watson-Jones+approach:+Technique+and+results.">Outpatient minimally invasive total hip arthroplasty via a modified Watson-Jones approach: Technique and results.</a> Instructional Course Lectures. 62, 229-236 (2013).</li><li>Rottinger, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+invasive+anterolateral+surgical+approach+for+total+hip+arthroplasty:+early+clinical+results.">Minimally invasive anterolateral surgical approach for total hip arthroplasty: early clinical results.</a> Hip International. 16, 42-47 (2006).</li><li>de Jong, L., Klem, T. M., Kuijper, T. M., Roukema, G. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+minimally+invasive+anterolateral+approach+versus+the+traditional+anterolateral+approach+(Watson-Jones)+for+hip+hemiarthroplasty+after+a+femoral+neck+fracture:+an+analysis+of+clinical+outcomes.">The minimally invasive anterolateral approach versus the traditional anterolateral approach (Watson-Jones) for hip hemiarthroplasty after a femoral neck fracture: an analysis of clinical outcomes.</a> International Orthopaedics. 42 (8), 1943-1948 (2018).</li><li>M&#252;ller, M., Tohtz, S., Dewey, M., Springer, I., Perka, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evidence+of+reduced+muscle+trauma+through+a+minimally+invasive+anterolateral+approach+by+means+of+MRI.">Evidence of reduced muscle trauma through a minimally invasive anterolateral approach by means of MRI.</a> Clinical Orthopaedics and Related Research. 468 (12), 3192-3200 (2010).</li><li>Kawarai, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+the+surgical+approach+influence+the+implant+alignment+in+total+hip+arthroplasty?+Comparative+study+between+the+direct+anterior+and+the+anterolateral+approaches+in+the+supine+position.">Does the surgical approach influence the implant alignment in total hip arthroplasty? Comparative study between the direct anterior and the anterolateral approaches in the supine position.</a> International Orthopaedics. 41 (12), 2487-2493 (2017).</li><li>Batailler, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Total+hip+arthroplasty+using+direct+anterior+approach+and+dual+mobility+cup:+safe+and+efficient+strategy+against+post-operative+dislocation.">Total hip arthroplasty using direct anterior approach and dual mobility cup: safe and efficient strategy against post-operative dislocation.</a> International Orthopaedics. 41 (3), 499-506 (2017).</li><li>D'Arrigo, C., Speranza, A., Monaco, E., Carcangiu, A., Ferretti, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Learning+curve+in+tissue+sparing+total+hip+replacement:+Comparison+between+different+approaches.">Learning curve in tissue sparing total hip replacement: Comparison between different approaches.</a> Journal of Orthopaedics and Traumatology. 10 (1), 47-54 (2009).</li><li>Rothwell, A. G., Hooper, G. J., Hobbs, A., Frampton, C. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+analysis+of+the+Oxford+hip+and+knee+scores+and+their+relationship+to+early+joint+revision+in+the+New+Zealand+Joint+Registry.">An analysis of the Oxford hip and knee scores and their relationship to early joint revision in the New Zealand Joint Registry.</a> The Journal of Bone and Joint Surgery. British Volume. 92 (3), 413-418 (2010).</li><li>Devane, P., Horne, G., Gehling, D. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Oxford+hip+scores+at+6+months+and+5+years+are+associated+with+total+hip+revision+within+the+subsequent+2+years.">Oxford hip scores at 6 months and 5 years are associated with total hip revision within the subsequent 2 years.</a> Clinical Orthopaedics and Related Research. 471 (12), 3870-3874 (2013).</li><li>Alexander, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Augmented+reality+for+acetabular+component+placement+in+direct+anterior+total+hip+arthroplasty.">Augmented reality for acetabular component placement in direct anterior total hip arthroplasty.</a> The Journal of Arthroplasty. 35 (6), 1636-1641 (2020).</li></ol>

微创手术 （MIS） 因其恢复更快、失血量更低和围手术期疼痛控制得到改善，在所有手术领域都引起了人们的兴趣。THA采用MIS来增加髋关节稳定性并增强术后活动。ABMS方法利用阔筋膜张肌和臀中肌之间的肌肉间隔，但不切开或分离肌肉和肌腱。考虑过渡到ABMS方法的外科医生最好参加尸体课程，最好由第一助手陪同。这将帮助他们熟悉关键的手术步骤9。应概述几个关键步骤：1）?...

在全髋关节置换术（THA）中，手术方法用于可视化髋臼和股骨近端，并为髋臼和股骨近端做好准备，以便安全稳定地植入假体部件1。THA 的理想手术方法可提供足够的暴露，同时最大限度地降低肌肉、血管和神经损伤的风险以及术后不稳定的风险。
THA中的前部肌肉保留（ABMS）方法利用了雷金纳德·沃森-琼斯爵士在1930年推广的肌肉间期2.ABMS 方法利用阔筋膜张量 （TFL） 和臀中肌 （GM） 之间的肌间平面进入髋关节。在这种方法中，外展肌得以保留，而不是脱落。由于 ABMS 入路位于 GM 和大转子 （GT） 的前方，因此它相似并具有直接前路 （DAA） 的优点 - 即保留肌肉。尽管 ABMS 方法可以在患者仰卧位进行，但许多外科医生更喜欢基于其原始描述的侧卧位3。
ABMS 与 DAA 一样，具有多种手术和术后早期益处。髋臼的暴露非常好，这有助于髋臼成分的最佳定位。由于肌肉损伤较少，因此脱位率较低，因此术后早期功能恢复更快4。
DAA 报告的缺点是股骨外侧皮神经受损 （LFCN）， 需要特殊的手术台， 伤口愈合问题， 以及股骨暴露更有限5，6.通过避免这些缺点，ABMS自2004年推出以来一直在欧洲国家常规使用，最近在北美引起了更多的关注3。动机是 1） 保留肌肉的方法的概念，该方法否定了术后预防措施的必要性7， 2） 能够以侧卧位进行手术，这允许通过后路 （PA） 进行 THA 的外科医生熟悉的稳定性评估操作， 3） 避免术中透视检查8，4）与DA相比，与LFCN的解剖距离增加，以及5）进一步的侧切口，避免了由悬垂的软组织引起的伤口愈合并发症，外科医生可能会决定过渡到ABMS方法。
然而，考虑过渡到THA的ABMS方法的外科医生担心过渡是否最终会改善患者的预后以及与过渡相关的学习曲线。因此，分析了由单个外科医生使用ABMS方法植入的第一批30个THAs，并与过渡前由同一外科医生通过PA植入的30个THA的结果进行比较。本研究测试了1）与PA组相比，ABMS组的早期患者报告结果是否有所改善，以及2）手术时间和并发症发生率是否随着THA的次数而降低。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>30&#176; Offset Masterloc Broach handle L</td>
			<td>Medacta</td>
			<td>01.10.10.461</td>
			<td></td>
		</tr>
		<tr>
			<td>30&#176; Offset Masterloc Broach Handle R</td>
			<td>Medacta</td>
			<td>01.10.10.460</td>
			<td></td>
		</tr>
		<tr>
			<td>3D Printed Acetabular Component</td>
			<td>Medacta</td>
			<td>01.38.058DH</td>
			<td></td>
		</tr>
		<tr>
			<td>ACE Wrap 6 in</td>
			<td></td>
			<td>140700</td>
			<td></td>
		</tr>
		<tr>
			<td>Acetabular Liner</td>
			<td>Medacta</td>
			<td>01.32.4048HCT</td>
			<td></td>
		</tr>
		<tr>
			<td>AMIS 2.0 Genera Tray</td>
			<td>Medacta</td>
			<td>01.15.10.0294</td>
			<td>Curved cup impactor</td>
		</tr>
		<tr>
			<td>AMIS 2.0 General Tray</td>
			<td>Medacta</td>
			<td>01.15.10.0293</td>
			<td>Screw driver for cup impactor</td>
		</tr>
		<tr>
			<td>Anterior Auxillery</td>
			<td>Medacta</td>
			<td>ALAUX</td>
			<td></td>
		</tr>
		<tr>
			<td>Biolox Ceramic Head</td>
			<td>Medacta</td>
			<td>01.29.214</td>
			<td></td>
		</tr>
		<tr>
			<td>Chloraprep 26 mL</td>
			<td>BD</td>
			<td>301185</td>
			<td></td>
		</tr>
		<tr>
			<td>Drape Mayostand</td>
			<td>Cardianal</td>
			<td>7999</td>
			<td></td>
		</tr>
		<tr>
			<td>Ethibond Size 5</td>
			<td>Ethicon</td>
			<td>103831</td>
			<td></td>
		</tr>
		<tr>
			<td>Femoral Neck Elevator</td>
			<td></td>
			<td>3006</td>
			<td></td>
		</tr>
		<tr>
			<td>Femoral neck elevator</td>
			<td></td>
			<td>01.15.10.0037</td>
			<td></td>
		</tr>
		<tr>
			<td>Ioban</td>
			<td>3M</td>
			<td>15808</td>
			<td></td>
		</tr>
		<tr>
			<td>Ketorolac 30 mg/mL</td>
			<td>SN</td>
			<td>MED00575</td>
			<td></td>
		</tr>
		<tr>
			<td>Masterloc Inst (MLOCINS)</td>
			<td>Medacta</td>
			<td>01.39S.301US</td>
			<td></td>
		</tr>
		<tr>
			<td>Masterlock Femoral Stem</td>
			<td>Medacta</td>
			<td>01.39.408</td>
			<td></td>
		</tr>
		<tr>
			<td>Mpact General (MPACT)</td>
			<td>Medacta</td>
			<td>01.32S.300US</td>
			<td></td>
		</tr>
		<tr>
			<td>Mpact Liner Trial face changing/offset</td>
			<td>Medacta</td>
			<td>01.325.305</td>
			<td></td>
		</tr>
		<tr>
			<td>Mpact Liner Trial face changing/offset</td>
			<td>Medacta</td>
			<td>01.325.305</td>
			<td></td>
		</tr>
		<tr>
			<td>Mpact liner trial flat/hooded</td>
			<td>Medacta</td>
			<td>01.32S.301</td>
			<td></td>
		</tr>
		<tr>
			<td>Mpact liner trial flat/hooded</td>
			<td>Medacta</td>
			<td>01.32S.301</td>
			<td></td>
		</tr>
		<tr>
			<td>Mpact Reamers (MPACT)</td>
			<td>Medacta</td>
			<td>01.32S.101US</td>
			<td>Regular hemi reamers swapped out for Half-Moon Reamers</td>
		</tr>
		<tr>
			<td>Single Prong Acetabular Retractor, Extra Deep</td>
			<td></td>
			<td>6570-01</td>
			<td></td>
		</tr>
		<tr>
			<td>Single Prong Acetabular Retractor, Standard</td>
			<td></td>
			<td>6570</td>
			<td></td>
		</tr>
		<tr>
			<td>Single Prong Broad Acetabular Retractor</td>
			<td></td>
			<td>6320</td>
			<td></td>
		</tr>
		<tr>
			<td>Stapler Kine Proximate Plus 35 W</td>
			<td>Ethicon</td>
			<td>52686</td>
			<td></td>
		</tr>
		<tr>
			<td>Tranexamic acid 1 g</td>
			<td>SN</td>
			<td>MED01071</td>
			<td></td>
		</tr>
		<tr>
			<td>Unger Narrow Hohmann</td>
			<td></td>
			<td>3002</td>
			<td></td>
		</tr>
		<tr>
			<td>Vicryl 1 CTX</td>
			<td>Ethicon</td>
			<td>143836</td>
			<td></td>
		</tr>
		<tr>
			<td>Vicryl 2-0 CT2</td>
			<td>Ethicon</td>
			<td>9174</td>
			<td></td>
		</tr>
	</tbody>
</table>

the transition to an anterior-based muscle sparing approach improves early postoperative function but is associated with a learning curve

考虑过渡到基于前路的THA方法的外科医生担心学习曲线和报告的边际临床益处。因此，分析了由单个外科医生使用基于前部的肌肉保留方法（ABMS）植入的第一批THA。该研究的目的是测试1）患者报告的结局是否有所改善，2）并发症发生率是否随着THA的次数而降低。使用 ABMS 方法对一名外科医生（2021 年 1 月至 2021 年 4 月）的前 30 例原发性 THA 病例（27 名患者）进行了回顾性队列研究。将这 30 例 THA 与同一位外科医生（2020 年 9 月至 2020 年 12 月）在过渡前立即使用后路 （PA） 进行的 30 例原发性 THA 病例（30 例患者）进行了比较。比较手术后6周和6个月获得的牛津髋关节评分（OHS），髋关节残疾和骨关节炎结局评分（HOOS Junior）和遗忘关节评分（FJS）。此外，比较了基于相同数量的THA的3个连续组的并发症发生率和手术时间。在THA后6周，ABMS方法后的OHS高出6分（p = 0.0408），OHS在6个月时相当。HOOS Junior和FJS在手术后6周和6个月相似。在使用ABMS方法的前10个THA中，一名患者出现大转子骨折，1名患者发生术中股骨近端骨折。没有进一步的直接术间或术后并发症发生。手术时间随着THA的次数而显着减少。从PA到ABMS方法的过渡与学习曲线相关，该曲线仅限于前20种情况。改善临床结局的效果在术后早期是显而易见的。6个月后，无论采用何种方法，THA患者都表现良好。

在THA后6周，ABMS方法后的平均OHS为35分，PA后为29分（p = 0.0408）。在THA后6周，ABMS方法和PA之间的HOOS和FJS没有显着差异。在THA后6个月，未观察到结局评分的差异（表1）。
在使用ABMS方法的前10个THA中，1例患者采用张力带缝合治疗大转子骨折，1例患者采用翻修锥股骨干治疗术中股骨近端骨折。没有进一步的直接术间或术后并发症发生。手术时间显著减少，THA的数量从...

Watch this Scientific Journal Video about The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve at JoVE.com

The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve

全髋关节置换术 （THA） 的基于前部的肌肉保留方法与学习曲线相关。然而，术后早期阶段临床结局的改善使得考虑过渡是值得的。

过渡到基于前部的肌肉保留方法可改善术后早期功能，但与学习曲线相关

Surgeons considering transitioning to an anterior-based approach for THA are concerned about the learning curve and the reported marginal clinical ...

该协议演示并强调了用于全髋关节置换术的前部肌肉保留方法（缩写为 ABMS）的技术和复杂性。ABMS 方法允许外科医生在侧卧位有效地进行全髋关节置换术，结合了后路和直接前路的优点。过渡到EBMS方法的外科医生应熟悉囊切开术期间包膜释放的程度，因为此步骤决定了髋臼和股骨的暴露。手术前，在术前保持区域与患者会面，并用皮肤标记标记正确的髋关节侧。触诊并标记大转子或GT的近端边界，股骨近端的前边界和臀中肌或GM筋膜的前缘，其比张量筋膜上覆盖的筋膜更紧。将患者置于侧卧位，手术髋关节朝上后，进行无菌准备和悬垂，并用碘浸渍粘合剂覆盖暴露的皮肤。将无菌弹性绷带缠绕在助手 1 的腰部以形成一条腰带，该腰带将用于用两个非穿透夹子固定在腰带上的无菌妙佑国际支架盖，就像袋鼠袋一样。将外科医生放在患者前面，助手 1 和助手 2 放在患者后面。指示助手 1 外展髋关节。用 10 号刀片将皮肤切开，沿着皮肤标记，用刀切到筋膜，然后用干净的实验室海绵露出筋膜。识别穿孔血管穿过筋膜时，定位 GM 和阔筋膜张量 （TFL） 之间的间隔。远端打开与筋膜纤维方向平行的筋膜，并在切口的中部向前弯曲，保持在穿孔血管的后方。要解剖前部TFL和臀肌之间的肌肉平面，请沿着GM向GT移动手指，让手指向前落入GM和TFL之间的空间。一旦手指进入该空间，通过向后抬高臀中肌和小臀肌来触诊股骨颈和股骨颈后部。当助手 1 握住外展的髋关节时，将弯曲的 Hohmann 牵开器放在囊外的后颈部以缩回臀肌，然后将直的 Hohmann 牵开器放在囊外的前颈部、TFL 和股直肌肌腱的反射头下方。指示助手 1 稍微向外旋转髋关节，并使用电灼术进行 H 形囊切开术，H 杆沿股骨颈纵向。确保 H 的远端线是连接 GT 尖端和颈部内侧的远侧线，以释放囊并清理转子窝和转子间脊。使用电烙术，从头部和髋臼边缘近端穿过整个胶囊，这感觉就像电烙尖端的台阶。在髋臼边缘，将电烙器旋转 90 度，然后沿髋臼边缘内侧和外侧释放胶囊。将牵开器重新定位在胶囊下方，助手在外展中握住腿。在助手1增加外旋和伸展的情况下，使股骨颈下凹由近端向远端斜切，以利于股骨远端的抬起。握住前 7 号牵开器。将钥匙升降机放置在截骨部位，将股骨颈水平到手术区域，同时助手 1 过度伸展髋关节以移开截骨术。指示助手 1 将腿放入袋鼠袋中并向外旋转臀部，使髌骨朝上，胫骨垂直于地板。将数字 17 牵开器重新定位在 GT 上，并使用电灼术从软组织中清理转子窝。指示助手 1 内收髋关节，使股骨颈抬高，远离伤口。要进行股骨颈切口，在转子窝远端的植物水平上，使用摆动锯切割内侧颈部，然后到侧颈部，注意不要违反GT。用截骨术取出股骨颈的游离骨片并抓握。取下 Hohmann 牵开器，并指示助手 1 将腿从袋子中取出放在妙佑医疗国际支架上的中立位置，以允许髋关节外展和轻微屈曲。将 15 号或 17 号牵开器放在后髋臼上，将数字 7 牵开器放在前髋臼上。用钉子推过胶囊。要移除股骨头，请推动头部的下部将其移位，然后使用抓手去除头部。用长刀去除盂唇，如果下囊位于髋臼半球，则切开它。将髋臼髋臼钋臼钼钋到适当的尺寸，从计划的杯子直径小 1 毫米开始，然后以 40 度外展和 10 至 15 度前倾插入最终髋臼成分。手动将最终聚乙烯衬垫放置在髋臼组件内，然后撞击髋臼组件中的衬垫以接合锁定机构，从而插入最终聚乙烯衬垫。助手 1 将腿放入袋鼠袋中并将臀部向外旋转 90 度，将 2 爪牵开器放在股骨颈的后内侧下方，将数字 17 牵开器放在 GT 上。然后指示助手 1 伸展并内收髋关节。沿 GT 的前部进行松解，将股骨从伤口中排出。然后用切箱刀和管式查找器打开股骨近端。拉刀到适当的尺寸和长度，并放置带有模板偏移的最终茎 要进行试验复位，请指示助手 1 施加轻微牵引力并在内部旋转髋关节，同时外科医生使用头部推杆将球引导到窝中。要检查髋关节的前部和后部稳定性，请将数字 17 牵开器放在后髋臼上以观察髋关节。在纵向和横向牵引下进行滑轮测试。要使髋关节脱臼，请在脖子上放置一个骨钩，并指示助手 1 施加牵引力和外旋。取下试验头，冲洗杯子，插入最后一个头，并缩小臀部。更换胶囊外的 17 号牵开器。用不可吸收的缝合线重新接近胶囊。在腿部轻微外展和外旋时，用合成编织可吸收缝合线修复臀筋膜。用2-0编织的可吸收缝合线在皮肤上关闭皮下组织，用无菌皮肤钉。全髋关节置换术后六周，前路肌保留或 ABMS 入路后牛津髋关节平均评分为 35 分，后路入路 （PA） 后平均髋关节评分为 29 分。两种方法在6周后，髋关节残疾和骨关节炎结局评分和遗忘关节评分无显著差异。在全髋关节置换术后6个月，未观察到结局评分的差异。3组患者平均手术时间的差异表明，手术时间从前10名患者的平均113分钟显着减少到手术21至30名患者的平均67分钟，表明手术效率的学习曲线。在六周时，就诊患者的术后X光片显示腿长和股骨偏移恢复。在臀中肌和阔张筋膜的边界切开筋膜将避免不必要的肌肉损伤，并且在囊切开术期间正确的囊膜松解将允许髋臼和股骨充分暴露。一旦熟悉了 ABMS 方法进行原发性全髋关节置换术，该方法就可以不受患者选择的限制，并且可以扩展到翻修全髋关节置换术。

Research

JoVE Journal

Medicine

Assessing Endothelial Vasodilator Function with the Endo-PAT 2000

评估与远藤的PAT 2000内皮血管舒张功能

The endothelium is a delicate monolayer of cells that lines all blood vessels, and which comprises the systemic and lymphatic capillaries. By virtue of ...

科研

医学

In Vivo Canine Muscle Function Assay

In Vivo Canine Muscle Function Assay

在犬体内的肌肉功能测定

We describe a minimally-invasive and reproducible method to measure canine pelvic limb muscle strength and muscle response to repeated eccentric 
...

A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology

方法论方法血管功能和形态的非侵入性评估

The endothelium is the innermost lining of the vasculature and is involved in the maintenance of vascular homeostasis.  Damage to the endothelium may ...

Early Detection of Drug-Induced Renal Hemodynamic Dysfunction Using Sonographic Technology in Rats

大鼠使用超声技术药物引起的肾血流动力学障碍的早期检测

The kidney normally functions to maintain hemodynamic homeostasis and is a major site of damage caused by drug toxicity. Drug-induced nephrotoxicity is ...

Adapted Resistance Training Improves Strength in Eight Weeks in Individuals with Multiple Sclerosis

改编阻力训练提高力量在八周内的个人与多发性硬化症

Hip weakness is a common symptom affecting walking ability in people with multiple sclerosis (MS). It is known that resistance strength training (RST) can ...

Using Saccadometry with Deep Brain Stimulation to Study Normal and Pathological Brain Function

使用Saccadometry与深部脑刺激来研究正常和病理脑功能

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including ...

Nerve-sparing Mid-urethral Obstruction (NeMO) in Female Small Rodents

Nerve-sparing Mid-urethral Obstruction NeMO in Female Small Rodents

在女小鼠害保留神经的中期尿道梗阻（NEMO）

Partial bladder outlet obstruction (pBOO) has a high prevalence, causes significant patient burden, and immense health care costs. The most common animal ...

A Non-Invasive Method for Generating the Cyclic Loading-Induced Intra-Articular Cartilage Lesion Model of the Rat Knee

一种生成周期负荷诱导的大鼠膝关节内软骨病变模型的非侵入性方法

The pathophysiology of primary osteoarthritis (OA) remains unclear. However, a specific subclassification of OA in relatively younger age groups is likely ...

Vessel-Sparing Microsurgical Longitudinal Intussusception Vasoepididymostomy to Treat Epididymal Obstructive Azoospermia

血管保留性显微外科纵向套叠血管表皮造口术治疗附睾梗阻性无精子症

The epididymis is a common site of obstruction in obstructive azoospermia (OA). Vasoepididymostomy has become an important method for the treatment of ...

Flexible Bronchoscopy for Novice Bronchoscopists

Systematic Bronchoscopy: the Four Landmarks Approach

Learning Systematic Bronchoscopy in a Simulation-Base Setting (Video) | JoVE

系统性支气管镜检查：四个标志方法

Flexible bronchoscopy is a technically difficult procedure and has been identified as the most important procedure that should be integrated into a ...