微创后外侧入路全髋关节置换的应用解剖  

Applied anatomy of the total hip arthroplasty through the minimally invasive posterolateral approach

作　　者：祝宗华[1] 郭涛[2] 徐文联[1] 李华杰[1] 张发惠 郑和平 

机构地区：[1]滁州市中西医结合医院骨伤科,安徽滁州239000 [2]安徽省武警总医院骨科,合肥230041 [3]南京军区临床解剖学研究中心,福州350000

出　　处：《中国临床解剖学杂志》2009年第6期654-657,共4页Chinese Journal of Clinical Anatomy

摘　　要：目的:为微创后外侧入路全髋关节置换的体表定位提供解剖学依据。方法:解剖观察30侧成人臀区标本,以同侧股骨大转子外侧缘最突出点(A点)与髂后上棘沿髂嵴向前3.0cm处(C点)作连线,A点与C点连线的中点处为B点,A、B两点连线即为所设计的长8.0cm微创全髋关节置换后外侧入路切口。了解臀上动、静脉、神经与臀下动、静脉、神经及坐骨神经和微创后外侧入路切口的解剖关系。结果:臀上神经及臀上动、静脉在梨状肌上孔处距切口的距离为(3.69±0.79)cm,臀下神经及臀下动、静脉在梨状肌下孔处距切口的距离为(5.83±1.21)cm,坐骨神经在梨状肌下孔以下距切口最近距离为(4.09±0.66)cm。结论:微创后外侧入路切口可有效避开重要神经血管,解剖学骨性标志定位简捷。Objective： To provide anatomic evidences for minimally invasive surgery of total hip arthroplasty through the posterolateral approcach, Methods： Gluteal region of 30 adult specimens were dissected and observed. A line was drawn between the highest point of the greater trochanter of femur＇s lateral border （point A） and the point 3 cm ahead of the posterior superior iliac spine （point C）, while the middle point of the AC line was taken as point B, The line between A and B was minimally invasive incision, with the length of 8.0 cm, for total hip arthroplasty through the posterolateral approach. The relevant anatomic features dealing with minimally invasive incision, including superior/inferior gluteal vessels and nerves and sciatic nerve were dissected and analyzed. Results： At the site of suprapitiform foramen, the distance between the superior gluteal vessels and nerves and the insicion was about （3.69±0.79）cm, however, at the site ofinfrapiriform foramen, the distance between the inferior gluteal vessels and nerves and the incision was （5.83 ±1.21）cm. The nearest distance from sciatic nerve to the incision below the infrapiriform foramen was about （4.09 ±0.66）cm. Conclusions： It is reliable to protect important nerves and vessels of gluteal area adopting minimally invasive posterior lateral approach. It is easy to locate bony markers during the operation.

关 键 词：髋关节 关节置换 微创 后外侧切口 应用解剖 

分 类 号：R323.44[医药卫生—人体解剖和组织胚胎学] R322.72[医药卫生—基础医学]