Anatomic Study And Primary Clinical Application Of The Anterior Minimally Invasive Approach To The Hip

Objective:A new minimally invasive approach for the hip joint surgery,which is named "Anterior Minimally Invasive Approach",was developed recently.The purpose of this study was to evaluate the theraputic efficiency of this new technique.Methods:1,We designed this new technique by optimized the approach to the hip joint on the basis of anatomy study,in which an adult cadaver(2 hips) was used.2,Between January 2006 and April 2008,29 patients with irreducible displaced femoral fracture underwent surgery by using the Anterior Minimally Invasive Approach(n=14),or the conventional Watson-Jones approach which served as the controls(n=15).3,Meanwhile,the new approach was used in the treatment of 5 patients with Legg-Calve-Perthes disease(LCPD),6 patients with pathological changes in the proximal femur,1 patient with femoral neck fracture and Parkinson's disease.And the outcome was observed.Results:1,The incision of the anterior minimally invasive approach was located from 1/8 to 1/4 part of the limb,forming a 20°angle with the thigh axis.And in this approach,muscular interval serves as the way to the hip joint. 2,There was significantly smaller incision size,less blood loss, shorter operation time and faster discharge in the MI group.There was no difference in the rates of union and complication between the two groups.3,There was small incision,little blood loss,short operation time and no clinical complication by using the anterior MI approach,in the treatment of patients with LCPD and pathological changes in the proximal femur.4,Hemiarthroplasty was performed in one patient with embolism of the right femoral artery observed later.The incision length was 9.8cm. Operation time was 90min.And blood loss was 350ml.5,There was a decline trend in the incision size,blood loss and operation time.Conclusion:1,The anterior MI approach appears to be a safe and efficient surgical approach associated with smaller incision size,less blood loss, shorter operation time,faster rehabilitation and higher satisfaction, compared with the conventional Watson-Jones approach.2,There was a learning curve in the application of MI approach, implying high surgical skill was required for surgeons who performed with this approach.