Hueter间隙在髋关节前路手术中的应用解剖学观察  

Applied anatomy of Hueter interval for direct anterior muscle-sparing approach to the hip

作　　者：王世栋[1,2] 邓雪飞[2] 韩卉[2] 尹宗生[3] 王伟[3] 胡勇[3] 

机构地区：[1]舒城县人民医院骨科,安徽舒城231300 [2]安徽医科大学人体解剖学教研室,合肥230032 [3]安徽医科大学第一附属医院骨科,合肥230032

出　　处：《中国骨与关节外科》2013年第1期43-46,49,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:目前通过Hueter间隙操作的髋关节前入路是微创意识的一种临床体现,其适应证及应用范围远不及传统后外侧入路。少数国外文献从临床应用角度涉及Hueter间隙的解剖结构,但缺少全面的研究和描述。目的:阐明Hueter间隙的组成、毗邻结构及其显露特点,为髋关节前路手术的安全操作提供形态学依据。方法:选取8例经福尔马林固定的成年湿性标本,5例行模拟手术入路观察,3例行断层解剖观察。结果:① Hueter间隙由两层肌间隙构成,浅层位于缝匠肌外侧缘与阔筋膜张肌前侧筋膜部之间,深层位于股直肌外侧缘与臀中肌前缘之间,两层不在同一平面,相距2 cm左右;②股外侧皮神经与Hueter间隙浅层关系分成垂直型和水平型,前者即股外侧皮神经横跨过间隙,神经走行轨迹与间隙成角>60°,后者即股外侧皮神经与间隙成角<60°,在阔筋膜张肌前缘筋膜部深面走行一段后潜出至股外侧皮下;③旋股外侧动脉升支紧贴间隙外侧、由下向上走行在Hueter间隙深层内,其走行轨迹与Hueter间隙深层呈平行关系。结论:熟悉Hueter间隙的组成、毗邻结构及其显露特点,有助于髋关节前侧入路的安全操作及缩短前路手术的学习曲线。Background： Hueter interval provides a true minimally invasive and few investigators have described its anatomical features. technique for hip surgery. But it has not gained popularity, Objective： To clarify the anatomic configuration and adjacent structures of the Hueter interval and define topographic land-marks to facilitate the direct anterior muscle-sparing approach to the hip, Methods： Eight specimens of adults were used： five cadavers were employed for simulated direct anterior muscle-sparing approach to the hip; and three cadavers were used for sectional anatomy. Results： Hueter interval was formed by superficial intermuscular plane and deep intermuscular plane. The former was locat-ed between the anterior border of tensor fasciae lata and sartorius, and the latter was located between the tensor fasciae lata and sartorius. The two layer planes were not on the same horizontal level and lied 2 cm apart. Perpendicular and parallel types were observed in the relationship between the lateral femoral cutaneous nerve and superficial intermuscular plane. The Hueter interval and the lateral femoral cutaneous nerve and superficial intermuscular plane were angulated at 〉60° and 〈60°, respectively. The ascending branch of the medial femoral circumflex artery lied close to the dissection plane and was found running along the intermucular plane inferior-anteriorly. Conclusions： Knowledge of the configuration, adjacent structures and topographic landmarks of Hueter interval facilitates the direct anterior muscle-sparing approach to the hip.

关 键 词：Hueter间隙 髋关节前路手术 股外侧皮神经 旋股外侧动脉升支 断层解剖 

分 类 号：R687.4[医药卫生—骨科学]