Anterolateral muscle sparing approach total hip arthroplasty： an anatomic and clinical study  

作　　者：ZHANG Xian-long SHEN Hao QIN Xiao-long WANG Qi 

机构地区：[1]Department of Orthopaedics, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China [2]Medical Department of Shanghai Medical Workers College, Shanghai 200237, China

出　　处：《Chinese Medical Journal》2008年第15期1358-1363,共6页中华医学杂志（英文版）

摘　　要：Background Many kinds of approaches have been used for minimally invasive surgery of total hip arthroplasty （MIS-THA）. However, until now when considering the balance of efficacy and associated surgical injury there is no approach widely accepted for MIS-THA. In this study, a modified anterolateral muscle sparing approach was developed to optimize MIS-THA. Methods Twenty adult cadaver specimens （40 hips） were used for anatomic research. The distance from anterior origin of the gluteus medius on the iliac crest to the anterior superior iliac spine was measured; the course of the superior gluteal nerve and the distances from the nerve to the regional anatomic landmarks were recorded. Simulated surgeries were performed in three fresh cadaver specimens to evaluate the soft tissues injury around incisions. From October 2004 to June 2006, 57 patients （57 hips） were treated with anterolateral muscle sparing minimally invasive total hip arthroplasty, of which 17 were femoral neck fractures, 9 osteoarthritis, 16 developmental dysplasia of hip （DDH） and 15 avascular necrosis （AVN）. All the operations were performed by the same senior surgeon. Operation time, blood loss and drainage volume were recorded and the correlation between the local complications and the native anatomical characteristics was especially noted. All cases were followed for at least 12 months. Results The distance from the anterior origin of the gluteus medius to anterior superior iliac spine along the iliac crest was （61±4） mm （range, 55-68 mm）, and the distance from inferior branch of the superior gluteal nerve to the anterior tubercle of the greater trochanter was （74±6）mm （range, 60-88 mm）. In simulated surgeries, excessive distraction of tissue was found to be the main cause of the anterior border injury of the gluteus medius muscle. Of the 57 patients treated with anterolateral muscle sparing MIS-THA, the average incision length was 9 cm （range 7.5-13 cm）. Blood transfusions were performed in 11 patients. Background Many kinds of approaches have been used for minimally invasive surgery of total hip arthroplasty （MIS-THA）. However, until now when considering the balance of efficacy and associated surgical injury there is no approach widely accepted for MIS-THA. In this study, a modified anterolateral muscle sparing approach was developed to optimize MIS-THA. Methods Twenty adult cadaver specimens （40 hips） were used for anatomic research. The distance from anterior origin of the gluteus medius on the iliac crest to the anterior superior iliac spine was measured; the course of the superior gluteal nerve and the distances from the nerve to the regional anatomic landmarks were recorded. Simulated surgeries were performed in three fresh cadaver specimens to evaluate the soft tissues injury around incisions. From October 2004 to June 2006, 57 patients （57 hips） were treated with anterolateral muscle sparing minimally invasive total hip arthroplasty, of which 17 were femoral neck fractures, 9 osteoarthritis, 16 developmental dysplasia of hip （DDH） and 15 avascular necrosis （AVN）. All the operations were performed by the same senior surgeon. Operation time, blood loss and drainage volume were recorded and the correlation between the local complications and the native anatomical characteristics was especially noted. All cases were followed for at least 12 months. Results The distance from the anterior origin of the gluteus medius to anterior superior iliac spine along the iliac crest was （61±4） mm （range, 55-68 mm）, and the distance from inferior branch of the superior gluteal nerve to the anterior tubercle of the greater trochanter was （74±6）mm （range, 60-88 mm）. In simulated surgeries, excessive distraction of tissue was found to be the main cause of the anterior border injury of the gluteus medius muscle. Of the 57 patients treated with anterolateral muscle sparing MIS-THA, the average incision length was 9 cm （range 7.5-13 cm）. Blood transfusions were performed in 11 patients.

关 键 词：surgical procedures  minimally invasive arthroplasty  replacement  hip 

分 类 号：R681[医药卫生—骨科学]