手术视频 ? 现场讲解 ? 病例展示 ? 术后问答

手术介绍

本视频是安徽省立医院尚希福教授录制的DAA入路全髋关节置换术；该术式是目前比较流行的前路微创全髋关节置换术，其技术核心是不损伤任何肌肉、从肌间隙入路全髋关节置换术，具有切口小，恢复快、术后肌肉力量恢复好、步态恢复快等优点，该患者取仰卧位，不需要特殊手术床，且不依赖特殊假体及特殊器械，使用普通全髋关节假体和器械就可以顺利完成手术，从而能达到术后快速康复的目的。该技术难点主要为股骨近端的暴露。

本视频从术前评估，模板测量到术中详细步骤进行了演示；详细讲解了DAA入路全髋置换术的优点、手术适应症、手术技术细节、以及术后快速康复过程，帮助各位骨科同仁对该项技术有初步的了解和基本技术掌握。

术者介绍

尚希福，医学博士，骨科主任医师，教授，骨科行政主任。安徽骨科学会常委，中华骨科学会关节组委员，华裔骨科学会理事，关节组委员。主攻骨关节病和骨关节肿瘤的诊断和治疗，骨科疑难杂症如股骨头坏死的治疗（自体骨髓移植治疗股骨头缺血性坏死获安徽省自然基金资助手术擅长：各种人工关节置换（髋关节、膝关节、肩关节和肘关节等）和骨肿瘤手术治疗。手术主要进行人工关节置换、肿瘤保肢和股骨头坏死的治疗，效果满意。

病例介绍

· 患者女性，74岁。

· 右髋关节疼痛十余年，加重伴活动受限1年。

· 患者自十年前始出现右髋关节疼痛，当时未予重视，近1年来右髋关节疼痛加重，行走困难，活动受限，口服止痛药无效，遂至我院门诊就诊。门诊查X线示：右髋骨关节炎。为进一步治疗，门诊以“右髋骨关节炎”收住我科。患者自发病以来饮食睡眠可，二便正常，体重无明显变化。

· 发育正常，营养良好，面容正常，表情自如，体型适中，步入病房，步态正常，自主体位，神志清楚，查体合作。跛行步入病房，右下肢稍短缩，右腹股沟压痛（+），右髋部叩击痛（+），右髋关节屈伸、内收内旋，外旋外展活动受限，足趾活动、血运及感觉正常。

· 右髋骨性关节炎，股骨头坏死。

参赛视频丨初次全髋关节置换手术展示

参赛作者 | 黄河

所属医院 | 南京市第一医院

技

参赛术式简介

初次全髋关节置换是关节外科的常规手术，本例为83岁女性，跌伤致股骨粗隆骨折，平日生活中活动半径较大，通常会选择近端髓内固定，但该患者合并阿尔茨海默症，家属考虑患者术后不能配合，内固定恐有失败的风险，要求行关节置换。本例中术者采用改良的Hardinge入路， 因患者大粗隆完整，手术应无太大难度，术者从控制手术质量的角度，试图通过视频展现手术过程中需要注意的细节问题，包括偏心距的测量、假体角度的评估和判断等等。

精彩片段展示

　　决战CAOS2016专家评审及大众评审将全面开启

各学组专业评审前5名的作品将入选现场总决赛

专业评审分数相同者以大众点赞票数优先为准

时间 |?2016年5月21日 18:00

坐标 |?成都国际会展中心

首届“骨科示教病例及手术视频评选活动”总决赛及颁奖典礼约起来！

手术视频｜直接前方入路全髋关节置换术

周五手术室

手术视频 ? 现场讲解 ? 病例展示 ? 术后问答

手术介绍

直接前方入路全髋关节置换术具有软组织损伤少，术后康复快等优势，是近年来国内髋关节置换领域的新兴手术方式。与传统的手术入路相比更符合现代关节外科快速康复的发展大趋势。直接前方入路髋关节置换术与传统的后侧入路和前入路的手术禁忌症是一样的。但有一些特殊的病例，如股骨近端的畸形较重、前倾角明显异常需要特殊假体、肌肉发达的男性患者等都有增加手术难度。

长按二维码进入周五手术室

术者介绍

马云青 | 解放军总医院第一附属医院

主治医师，专业技术10级，毕业于解放军第四军医大学七年制临床专业。2007年至今在解放军总医院第一附属医院关节外科工作，曾在美国Mayo Clinic、纽约Beth Israel医院、费城Thomas Jefferson大学附属医院进修学习。主要从事各种骨与关节疾病的诊治，擅长前路微创人工髋关节置换术、人工膝关节置换，综合治疗股骨头坏死、骨关节炎、类风湿关节炎、创伤性关节炎等疾病。曾在《中华外科杂志》、《中华骨科杂志》、《中国骨与关节外科》等专业刊物发表10余篇学术论文。

分享病例

患者女性，52岁。

· 主诉

跛行步态

双髋关节长距离负重活动后疼痛

髋关节活动范围受限

· 现病史

双髋关节长距离负重活动后疼痛不适，跛行，休息后可缓解不影响睡眠。

双髋关节屈曲活动受限，穿袜子、鞋受限，日常生活质量受影响。

· 查体

双下肢不等长（左侧THA术后），右下肢相对长度短缩2cm；

右髋关节无明显压痛、叩痛，“4”字实验阳性；

右髋关节活动度：屈曲90°，后伸0°，外展10° 内收10°，外旋10°，内旋0°；

右髋关节Thomas征（-），Trendenlenburg征（-）。

· 诊断

右髋关节发育不良（CroweⅡ型）

左髋关节置换术后

▼术前影像

▼手术直击影像

▼术后X线

· 术后处理

术后常规给予预防感染、预防下肢静血栓治疗。

术后第二天辅助助行器下地活动。

卧床时可行股四头肌，髂腰肌肌力锻炼。

术后五天复查下肢静脉彩超和髋关节X线片，如无异常出院。

髋关节置换手术记录

姓名：xxx 性别：女性 年龄：70岁 住院号：21853

病室：[住院外科] 床号：22

手术日期：2014年03月20日 主管医生：xx

术前诊断：1.左股骨颈骨折；2.高血压；3.II型糖尿病

术后诊断：1.左股骨颈骨折；2.高血压；3.II型糖尿病

手术名称：左股骨颈骨折全髋置换

麻醉方式：全麻 体位：侧卧位

手术发现及程序

术中发现：左侧股骨颈骨折，骨折线从头下波及基底部，有移位、成角。

步骤：麻醉生效后患者取侧卧位，术区常规消毒、铺单，帖皮肤保护膜。采用改良后外侧入路，起自髂后上棘前方6-7cm，向前下绕大粗隆前缘沿股骨向下延伸，长15 cm, 依次切开皮肤、皮下组织和深筋膜，电凝止血。自下而上切开阔筋膜及阔筋膜张肌，钝性分开臀中肌和臀小肌的后缘，向前牵开，在转子窝处切断梨状肌等外旋肌群的附着点，切断部分股方肌，显露并切除关节囊。关节囊不厚；关节腔内可见陈旧性积血；滑膜未见明显增生。取出股骨头，关节软骨未见退变。髋臼未见明显病变。在小转子上15 mm截骨，切除残余、紧张的关节囊，切除关节盂缘，清除圆韧带，用48至50 mm的髋臼锉锉除髋臼软骨至软骨下骨质，试模测之，大小为50 mm，打入52 mm的压配型髋臼假体，使其外展角为45度，前倾角为10度，稳定，放入高分子聚乙烯内衬。以盒式开口凿股骨近端髓腔开口，髓腔扩大器扩大股骨髓腔至10mm，再用髓腔成形锉扩大髓腔至10号，前倾角为15度。以中颈试模测试，软组织松紧适中，活动良好、稳定，冲洗股骨髓腔，选用压配型的10号股骨假体，缓慢打入髓腔，安放中颈股骨头，关节复位。冲洗切口，彻底止血，置胶管引流一根另开口引出，依次关闭切口，术毕。术中出血约1600ml，术中用电刀止血。用大量生理盐水冲冼，清点纱布、器械无误，逐层缝合，酒精敷料包扎。麻醉满意，无不良反应。手术顺利结束，患者安返病房，术后抗感染、补液、止血、对症治疗。

手 术 者：xxx主治医师、xx主治医师、xxx医士

麻 醉 者：xxx

洗手护士：xx

巡回护士：xxx

手术医师： 记录：

记录日期：2014年03月20日

支架辅助前路全髋关节置换术（附手术视频）

支架辅助前路全髋关节置换术手术视频 ?↓ ↓ ↓

Abstract

Purpose Acetabular component position is important for stability and wear. Fluoroscopy can improve the accuracy of acetabular component placement in the posterior approach and the direct anterior approach (DAA). The purpose of this study was to determine if the direct anterior approach in the supine position facilitates the accurate use of fluoroscopy and improves acetabular component position.

Methods This retrospective, comparative study of 60 THAs with fluoroscopic guidance (30 in posterior approach group and 30 in DAA group) was performed by one surgeon from 2012to 2014 at a single institution.Demographic and perioperative data were compared using the Kolmogorov-Smirnov test to determine if they were statistically different.Thedifference between the measured intra-operative and postoperative values for both inclination and anteversion were analysed respectively.

Results In the posterior approach group we found an average inclination on intra-operative fluoroscopy (IFluoro) of 36.8°± 3.72°, an average anteversion on intra-operative fluoroscopy (AFluoro) of 25.6°±3.64°, an average inclination on postoperativestandingAPpelvisX-ray(IAP X-ray)of39.29°±4.58°and an average anteversion on postoperative standing AP pelvis X-ray (AAP X-ray) of 21.31°±4.04°. In the DAA group we?found an average DAA IFluoro of 42.32°±1.91°, an average DAA AFluoro of 22.3°±1.41°, an average DAA IAP X-ray of 42.98°±1.81° and an average DAA AAP X-ray of 22.88°± 1.38°. A difference was seen in variability using Kolmogorov-Smirnov test for inclination and anteversion with significant higher variation of measurements in the posterior approach group (p=0.022 and p<0.001 respectively).="" no="" statistically="" significant="" difference="" was="" seen="" in="" the="" daa="" group="" using="" the="" fluoroscopy="" for="" inclination="" and="" anteversion.="" conclusion="" using?fluoroscopy="" in="" the="" direct="" anterior="" approach,="" we="" achieved="" better="" intra-operative="" assessment="" of="" cup="" orientation="" resulting="" in="" decreased="" variability="" of="" acetabular="" cup="" anteversion="" than="" when="" used?in="" the="" posterior="" approach.atleast="" some="" of="" the="" improvement="" was="" due="" to="" the="" fact="" that="" the="" fluoroscopic="" image="" in="" the="" supine="" position="" was="" more="" accurate="" as="" measured="" against="" the="" postoperative="" standing="" ap="" pelvis.="" this="" study="" may="" influence="" the="" choice="" of="" approach="" in="" total="" hip="">

Keywords?Directanteriorapproach(DAA) .Posterior approach .Fluoroscopy .Acetabularcomponent .Inclination . Anteversion

Introduction

A review of the literature on total hip arthroplasty would suggest that accurate placement of the acetabular component is both important and difficultto achieve. Methods are available to help?ensure?accurate component positioning including fluoroscopy[1,2],computer navigation[3,4], and robotics[5,6]. This study focuses on the use of fluoroscopy to help assure correct acetabular component orientation.

Multiple authors have assessed acetabular cup position in hip arthroplasty. Lewinnek et al. suggested a radiographic

definition for ideal acetabular component position as 15° (±10°) of anteversion and 40°±10° of abduction [7]. Cups placed outside this zone had a higher dislocation rate [8]. Furthermore, cups placed outside this zone also experience higher biomechanical stresses leading to increased rates of polyethylene wear and osteolysis [9, 10]. Hard-on-hard bearings are possibly more sensitive to acetabular malposition than hard-on-soft bearings [11]. With metal-on-metal implants, increased abduction and anteversion angles have repeatedly correlated with higher serum metal ion levels, a marker for wear [12–14].These studies support that both stability and wear are affected by cup position.

Several studies conducted by experienced surgeons at prominent institutions have looked at the accuracy of acetabular component position when using traditional methods utilizing mechanical guides and anatomic landmarks such as the anterior superior iliac spine and pubic symphysis [7] and transverse acetabular ligament [15, 16]. In this setting, component position is dependent on the surgeon’s interpretation of the position of the patient’s pelvis on the operating table. Internal and external landmarks, which may be obscured [17, 18] by body habitus or the use of smaller incisions/minimally invasive techniques are also utilized [19].

A recent study by Barrack et al. [20] of 1,549 total hips found that only 88 % of acetabular components were within broadtarget range(abduction30–55°andanteversion5–35°). WhenCallananetal.[21]reviewed1,823hips,only38%met a more stringent component position target range (abduction 30–45°andanteversion5–25°).Thesestudies,andothers[22, 23], would suggest that techniques that improve acetabular component position could have value.

A study by Rathod et al. [24] has shown that fluoroscopy with anterior hip arthroplasty reduced the variability of acetabular cup positioning compared with a non-guidedposterior approach. Another study by Beemer et al. [2] suggested that the use of fluoroscopy with posterior hip arthroplasty may increase accurate placement of acetabular components for surgeons performing amixofprimary,revision,andcomplicated total jointarthroplasties.From previousstudies,itisunclear if the value of fluoroscopy is similar when used in the posterior approach as compared to the anterior approach. It is the purpose of this study to determine if the direct anterior approach in the supineposition facilitates the accurate use offluoroscopy and improves acetabular component position.

Materials and methods

A prospectively maintained database of THAs performed by the senior surgeon (N. Stewart) at one centre from May 2012 to November 2014 was reviewed for this retrospective?comparative study. A consecutive series of patients who underwent primary THAs, unilateral or staged bilateral, with a cementless hemispheric acetabular design and cementless tapered wedge femoral component (Stryker orthopaedics company) were included in the study.

TheEMRwasusedtoobtaininformationfromeachpatient including laterality of the operatively treated hip; performing surgeon; age, sex, height, weight, and BMI of the patient; femoral head size utilized; acetabular cup outer diameter; surgical approach; and pre-operative diagnosis. Patients were required to have a standing postoperative digital anteroposterior pelvic radiograph of acceptable quality, according to criteria previously described by Callanan et al. [21]. Hips without adequate radiographs were excluded. This series consisted of 60 patients undergoing THA. The senior surgeon converted from a posterior approach to performing nearly all his primary hips from a direct anterior approach as of December26,2013. After this date, only patients with a severe Dorr type A femoral geometry were replaced with a posterior approach. We reviewed a consecutive number of patients with a direct anterior approach, of the first 34, 30 had adequately preserved intra-operative fluoroscopy films and a quality postoperative APpelvisX-ray and were included. Working back in time,we again neededto review 34 patients operated upon via the posterior approach to find 30 with adequately persevered intraoperative fluoroscopic films and quality postoperative study films.

At posterior approach surgery,the patients were placed in a lateral decubitus position with firm supports on a peg board for the anterior pelvis, chest, sacrum and dorsal spine to keep the patient in a stable position throughout the surgery. Once the acetabulum component was placed, fluoroscopy was used to confirm placement. To ensure proper orientation of the fluoroscopic beam tangential to the pelvis,theC-arm was first adjusted to align the centre line of the sacrum with the pubic symphysis.Next,theC-arm was adjusted to make the shape of the obturator on the fluoroscopic image match the shape of the obturator on the pre-operative standingAPpelvisX-ray.Then the position of the acetabulum was assessed with afluoroscopic view that placed the cup near the centre of the screen while still allowing visualisation of the pubic symphysis to provide vertical reference of the pelvic position (Fig. 1).

The anterior approach was performed using the Arch table extension (Orbiswiss company) on a slider table (Steris Corporation) surgical bed (Fig. 2). After anaesthesia, the patient was placed in a supine position. In the supine position, the midline of the sacrum was checked to see if it was aligned with the pubic symphysis.Then the projection of the obturator foramen was evaluated subjectively by the surgeon and the C arm manipulated to have the fluoroscopic image match the pre-operative standing AP radiograph view of the pelvis (Fig. 3a and b). At the time of acetabular insertion, a

Fig.1?Fluoroscopic image allows assessing the position of the acetabular cup in a posterior approach after final cup placement

fluoroscopy view with the cup near the centre, and the pubic symphysis in the view, was used to confirm cup placement (Fig. 4). With either approach, the target inclination was 40° (±10°) and anteversion was 15° (±10°).

Geometric analysis was performed on both intra-operative fluoroscopic images of final cup position and six-week postoperative anteroposterior pelvic radiographs. Geometric

Fig.2?The ArchTable Extension is a special table attachment that allows controlled movement of the extremity during preparation of the femur and acetabulum.

Fig. 3?a Fluoroscopic image obtained with the patient in the supine position on the operating room table with the C-arm beam positioned such that the intraoperative image matches the preoperative image. b The shape of the obturator foramen and the pubic symphysis are noted by the surgeon.

assessmentof the radiographs was performed byanorthopaedic surgeon (WF. Ji) not involved in the surgeries. Measurements included cup abduction angle and cup anteversion angle. Pre and postoperative AP radiographs were taken with patients in the standing position with hips in neutral position, the radiation beam centred on the pubic symphysis, and filmfocus distance approximately 120 cm.

A picture archiving and communications system (PACS) software (Fujifilm, Stanford, CT, USA) was used to make the measurements. With regard to validity and convenience for calculation, we chose the method described by Lewinnek and Widmer for measurement of anteversion of the acetabular component [25]. It has been shown to be a valid and reliable methodfor radiographic analysisofcup anteversion [26].Acetabular inclination on the postoperative film was measured as the angle between the interteardrop line and the long axis of the acetabular cup face. On the intra-operative fluoroscopic view, the pubic symphysis was used to determine the vertical orientation of the pelvis (Fig. 4).

Fig.4?Fluoroscopic image allows assessing the position of the acetabular cup in the direct anterior approach (DAA) during and after final cup placement.

The difference between the measured intra-operative and postoperative value for both inclination and anteversion were calculated. Variances (square of the SDs) were used to define the variability of the outcome measure. They were compared using the Kolmogorov-Smirnovtest to determine if they were statistically different. An independent t-test (two tailed) was used for normally distributed continuous data and the Mann–Whitney U test was used for nonparametric data. Chi-square and Fisher’s exact tests were used for comparing categorical data. A p value of 0.05 was set as the level of statistical significance. The 95 % limits of agreement method was used to assess the agreement between intra-operative fluoroscopy and postoperative standing AP pelvis. First, the mean and SD of the differences between the two methods were calculated. Second, the 95 % limits of agreement were calculated as mean difference ±1.96 SD. Plots of differences against means were used to examine the assumptions of the limits of agreement. Statistical analysis was performed using SPSS software (version 16; Chicago, IL, USA).

Results

Demographic and perioperative data are presented in Table 1. There was no significant difference in patient age, sex, operative side, diagnosis, cup size, or femoral head size between the two groups.

Mean acetabular inclination and anteversion values within the two groups are summarised in Table 2. A difference was seen in variability using Kolmogorov-Smirnov test for inclination and anteversion with significantly higher variation of measurements in the posterior approach group for both variables (p=0.022 and p<0.001>

For the evaluation of both precision and bias of intraoperative fluoroscopy, the difference between the cup inclination measured by fluoroscopy(IFluoro) and cup inclination measured by postoperative standing APpelvisX-ray(IAP X-ray) was calculated. We did the same calculation between intraoperative anteversion(AFluoro) and postoperative anteversion(AAP X-ray). The mean difference and 95% confidence intervals for each of these measures are shown in Fig. 5a–d.

The results in Fig. 5a and b demonstrate that 95 % of the time the fluoroscopic view in the supine position is between no more than 3.5° less or 2° more than the value found on a post operative standing AP X-ray. Similar values for anteversion are an underestimate of 3.8° to an overestimate of 2.2°.

The results in Fig. 5c and d demonstrate that 95 % of the time in the posterior position the fluoroscopic measure of inclination isbetween 11.6°less and 6.0°morethanthe inclination on the standing AP X-ray. Similar values for anteversion are an underestimate of 4.0° and an overestimate of 11.0°.

Discussion

Acetabular component position is important for endoprosthesis survival [27, 28], wear [22], hip load [29], and range of motion (ROM) [30]. Multiple techniques have been promoted to enhance the accuracy of component positioning, including the use of fluoroscopy [1, 2, 24], computer navigation [31, 32], and robotic assistance [5, 6]. Of these three, fluoroscopy is the most widely available and least expensive to adopt. This paper compares the accuracy of

fluoroscopy to the postoperative standing AP radiograph in both the lateral and supine positions.

Rathod et al. [24] demonstrated that an anterior approach with fluoroscopy allowed more accurate acetabular positioning than a posterior approach without fluoroscopy. It’s unclear if the improvement in that sense was due to the use of fluoroscopy or the change in approach. Beemer et al. [2] demonstrated that the use of fluoroscopy can improve component position in the posterior approach. Our results demonstrate that when using fluoroscopy in the anterior approach, we achieved better results than when used in the posterior approach (Fig. 6). At least some of the improvement was due to the fact that the fluoroscopic image in the supine position was more?accurate as measured against the postoperative standing AP pelvis. Relying on the fluoroscopic guided direct anterior approach in the supine position, the DAA surgeons were able to improve their accuracy and consistency to position the acetabular component in the safe zone for inclination and anteversion.

While our study shows that fluoroscopy is more accurate and consistent in the supine position, it’s unclear if the degree of improvement is clinically significant. While detailed longterm studies need to determine to what extent we must optimize component position, it’s hard to argue against a technique which improves accuracy if it is relatively safe and inexpensive. Compared to computer navigation and robotics, fluoroscopy is routinely available, and thus not expensive.

Fig. 5?Deviation of the intraoperative fluoroscopic values from postoperative standing AP pelvis values compared to their mean. a Direct anterior approach (DAA) inclination. b DAA anteversion. c Posterior approach inclination. d Posterior approach anteversion. Dotted lines represent the 95% limits of agreement (Bland-Altman graph)

Fig. 6?A six-week postoperative anteroposterior standing pelvic radiograph showing bilateral total hip arthroplasties (THAs). The right hip was placed by the same surgeon in the directanterior approach(DAA) using fluoroscopy assistance,whereas the leftwas placed in the posterior approach using fluoroscopy assistance. (Inclination: left 51.65, right 45.26; Anteversion: left 30.35, right 21.37)

The radiation dose, while not measured in this study, is generally quite small.

This study may influence the choice of approach in total hip replacement. If a surgeon wishes to adopt a technology that assists with component positioning, and chooses fluoroscopy, using the direct anterior approach would make that technology more effective. There are other considerations in choosing an approach [21, 33–39], but these findings may factor into that discussion.

Continued research into accurate component positioningis needed.Comparing fluoroscopic guidance to navigation,orto robotics, would help determine which technologies provide greater benefit. Even in skilled and experienced hands, accurate component positioning is not always achieved, and so technologies that help with this task will likely continue to gain acceptance.

Acknowledgments?The authors wish to thank Carol for the fluoroscopic image and the standing AP pelvis X-ray acquisition, and Shen Jing M.D., for assisting the statistical analysis.

References

1. Matta JM, Shahrdar C, Ferguson T (2005) Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res 441:115–124

2. Beamer BS, Morgan JH, Barr C, Weaver MJ, Vrahas MS (2014) Does fluoroscopy improve acetabular component placement in total hip arthroplasty? Clin Orthop Relat Res 472:3953–3962. doi:10. 1007/s11999-014-3944-8

3. Ryan JA, Jamali AA, Bargar WL (2010) Accuracy of computer navigation for acetabular component placement in THA. Clin Orthop Relat Res 468:169–177. doi:10.1007/s11999-009-1003-7

4. NoglerM,MayrE, KrismerM,ThalerM (2008) Reducedvariability in cup positioning: the direct anterior surgical approach using navigation. Acta Orthop 79:789–793. doi:10.1080/ 17453670810016867

5. NawabiDH,CondittMA,RanawatAS,DunbarNJ,JonesJ,Banks S, Padgett DE (2013) Haptically guided robotic technology in total hip arthroplasty: a cadaveric investigation. Proc Inst Mech Eng H 227:302–309

6. Domb BG, El Bitar YF, Sadik AY, Stake CE, Botser IB (2014) Comparison of robotic-assisted and conventional acetabular cup placement in THA: a matched-pair controlled study. Clin Orthop Relat Res 472:329–336. doi:10.1007/s11999-013-3253-7

7. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60:217–220

8. Jolles BM, Zangger P, Leyvraz PF (2002) Factors predisposing to dislocation after primary total hip arthroplasty: a multivariate analysis. J Arthroplasty 17:282–288

9. Patil S, Bergula A, Chen PC, Colwell CW Jr, D’Lima DD (2003) Polyethylene wear and acetabular component orientation. J Bone Joint Surg Am 85-A(Suppl 4):56–63

10. Little NJ, Busch CA, Gallagher JA, Rorabeck CH, Bourne RB (2009) Acetabular polyethylene wear and acetabular inclination and femoral offset. Clin Orthop Relat Res 467:2895–2900. doi: 10.1007/s11999-009-0845-3

本文来自季卫锋的投稿

个人简介

医学博士、师承博士后,副教授，副主任中医师.中华中医药学会骨伤分会关节病委员、浙江省中西医结合学会骨质疏松分会委员。留学美国Chipppewa?Valley、日本Juntendo?university骨科及运动医学中心。

擅长：髋关节疾病、膝关节病、肩周炎、颈椎病、腰椎间盘突出症、骨质疏松相关疾病及运动损伤的诊治和中医药治疗。人工关节置换术、髋膝关节镜、腰椎间盘摘除术、创伤骨折内固定术、骨质疏松性椎体骨折的椎体成形术等。

主持和参与国家级、省部级等研究课题6项，获科研奖项多项，其中省政府科技进步奖3项.已在国际和国内学术期刊上发表论文20余篇，参编多部专著。

转载请注明出处范文大全网 » 手术视频|前路微创全髋关节置换术