The Anatomical Study And Clinical Application Of DAMIS Total Hip Arthroplasty

Objective:Hip joint disease has become a common disease and frequently encountered disease in orthopedics,each year due to congenital hip dysplasia,trauma,hormones or drinking,lead to hip arthritis,femoral head necrosis,etc.More and more patients with hip joint disease.There are a large part of the patients with poor economic capacity,and insufficient understanding of the hip joint disease,cause severe hip disease.For such people,particularly in elderly patients,is an urgent need to find a slight injury,quick recovery,surgical treatment method for the treatment of low cost.This subject through anatomic studies of DAA(direct anterior approach),provide the morphological basis for hip surgery through direct anterior approach,at the same time to conduct a comprehensive evaluation for DAMIS(Direct anterior minimum invasive surgery)patients in our department,in order to find more methods to reduce the risk of surgery and complications.Methods:1.Anatomical studyChoose 3 cases of formalin fixed adult wet specimens,simulation approaches observation,clear the relationship of surgical incision and lateral femoral cutaneous nerve(LFCN),the femoral nerve,muscles and soft tissue around the approach,at the same time,to know whether this approach have adverse effect to the gluteus medius muscle,gluteus minimus muscle and rectus femoris muscle.2.Clinical studyCollected clinical data,contrast research the clinical curative effect of Direct anterior approach with the Direct lateral approach(DLA),Posterolateral approach(PLA)for total hip replacement,observe and statistic operation time,intraoperative blood loss,complications and postoperative reactions such as Harris hip score function rehabilitation of related indicators.Results:1.Anatomical studyDAMIS minimally invasive surgery of total hip replacement in path of Smith-Peterson interval into hip,its located in the anterior lateral,from anterior superior iliac spine,stop at perineum plane,consists of two layers of muscle clearance,shallow layer between tensor fascia latae and sartorius,deep layer between gluteus medius muscle and rectus femoris muscle,LFCN through the surgery zone and a branch of the lateral femoral circumflex artery parallel contorts in deep layer.2.Clinical study(1)Compared with the posterolateral approach: the intraoperative blood loss and incision length,postoperative of 6 weeks,3 months follow-up Harris hip score of DAMIS group is better than that of the posterolateral approach group.But patients' hospitalization days,operation time and postoperative 6 months and 12 months of follow-up Harris hip score has no significant difference.(1)Compared with Direct lateral approach: DAMIS group is better in the intraoperative blood loss,incision length,operation time and postoperative of 6 weeks,3 months follow-up Harris hip score.Patients' hospitalization days,and postoperative6 months and 12 months of follow-up Harris hip score has no significant difference.Conclusion:1.DAMIS surgical approach is a kind of internervous intervals and muscle-sparing minimally invasive approach,only the LFCN and a branch of the lateral femoral circumflex artery through surgery zone,without any cut of muscles and tendons around the hip during the operation;2.The advantages of DAMIS are small trauma,shorter recovery time,effectively reduce the risk of complications such as dislocation of the hip compare with traditional approach,but its advantage is mainly manifested in the early phase,the long-term curative effect and no obvious difference;3.DAMIS had obvious learning curve as a new technology,for beginners has the certain difficulty,the risk of surgical complications occurred in the early stages of the learning curve and even bigger than the traditional approach,this has become a great hindrance in development and promotion of this technology.