摘要
目的:探讨微创全髋关节置换术前外侧肌间隙入路改良,手术安全区和评价手术对软组织的损伤。方法:解剖20具成年尸体标本(40髋),测量臀中肌前缘在髂嵴处起点距髂前上棘的距离;记录臀上神经的走行及与周围解剖标志的距离;进行统计学分析,提出改良方案。对3具新鲜灌注尸体的一侧模拟改良微创全髋置换术,观察切口周围软组织的损伤情况。结果:臀中肌前缘距髂前上棘距离(6.1±0.4)cm(5.5～6.8cm);经大转子外侧最凸点分别作与髂后上棘连线、髂嵴垂直连线、臀中肌前缘与髂嵴的交点和与髂前上棘连线方向上,臀上神经下支距大转子外侧最凸点的距离分别为(10.0±0.8)cm(7.7～11.6cm)、(9.1±0.8)cm(7.2～10.3cm)、(7.4±0.6)cm(6.0～8.8cm)和(8.8±0.7)cm(6.7～9.6cm);3例髋模拟改良前外侧肌间隙入路全髋置换术后,解剖发现损伤集中于臀中肌前缘的肌腹处,以挫裂伤为主,同时观察第1例模拟手术后有臀上神经终支断裂。结论:(1)前外侧肌间隙入路手术皮肤切口方向可选择从大转子最凸点指向髂前上棘沿髂嵴方向后方6.0cm,切口近端长度和操作控制在距大转子最凸点6.0cm的"安全区"以内;(2)前外侧肌间隙入路做到了肌肉间隙操作,充分的手术操作培训,可避免术中对软组织和神经的损伤。
Objective： To evaluate the clinic effects of the improved minimally invasive total hip arthroplasty through anterolateral intermuscular approach, and explore the safety and injury degree of soft tissues during the procedure. Methods： 20 adult cadaver hips （40 sides） were selected. The distance from the anterior border of gluteus medius to anterior superior iliac spine was measured, the orientation and location of the superior gluteal nerve was recorded. Improved approach was adopted according to the data analyzed statistically. Mimic operation was taken on 3 fresh cadavers to assess the injury degree of soft tissues around incisions. Results： The distance from anterior border of the gluteus medius to anterosuperior iliac spine was about （6.1±0.4）cm （5.5 -6.8）cm. The distance from the lateral protrusive point of greater trochanter to the inferior branch of superior gluteal nerve on the lines from the lateral protrusive point of the greater trochanter to the posterior iliac spine, the iliac crest, the point 6cm above the anterior superior iliac spine （ASIS） and ASIS were respectively （ 10.0±0.8）cm （ 7.7 - 11.6 cm）, （9.1 ±0.8）cm （ 7.2 - 10.3 cm ）, （7.4±0.6）cm （ 6.0 - 8.8 cm ）and （8.8±0.7）cm （6.7 -9.6 cm）. Mimic operation showed that the injury of gluteus medius belonged to contusion focusing on the anterior border of muscle belly, however the disrupted inferior branch of the superior gluteal nerve was found in 1 case. Conclusions： （ 1 ）Anterolateral intermuscular approach should be located from the lateral protrusive point of greater trochanter to the posterior aspect of anterosuperior iliac about 6.0cm along iliac crest. The proximal portion of the incision limits within 6cm from the lateral protrusive point of greater trochanter. （2） anterolateral intermuscular approach is safe and reliable.
出处
《中国临床解剖学杂志》
CSCD
北大核心
2008年第3期255-258,共4页
Chinese Journal of Clinical Anatomy
基金
上海申康医院发展中心项目(SHDC12006103)
关键词
髋关节
关节置换术
手术入路
微创外科
应用解剖
hip joint
arthroplasty
operative approach
minimally invasive surgery
applied anatomy
