直接前侧入路微创全髋关节置换术中股外侧皮神经损伤的研究进展  

Research progress of the lateral femoral cutaneous nerve injury during total hip arthroplasty with a direct anterior approach

作　　者：高辉[1] 叶山山 何春耒[1] 陈震东[3] 刘承鸿 

机构地区：[1]赣南医学院第一附属医院骨科,江西省赣州市341000 [2]赣南医学院2015级骨科学研究生 [3]赣南医学院2014级骨科学研究生 [4]南昌大学医学院

出　　处：《中华解剖与临床杂志》2017年第3期248-251,共4页Chinese Journal of Anatomy and Clinics

基　　金：江西省卫生和计划生育委员会计划项目（20175369;20175391）

摘　　要：目的探讨直接前侧人路微创全髋关节置换术中的股外侧皮神经损伤发生的原因及预防方法。方法分别以“直接前侧入路”、“股外侧皮神经”为关键词在PubMed及CNKI的中国期刊全文数据库检索2005年1月-2016年5月关于直接前侧入路微创全髋关节置换术中股外侧皮神经损伤的原因及损伤方法和相关文献，对最终筛选出的28篇相关文献进行分析总结。分析直接前侧入路、Heuter间隙、股外侧皮神经的的解剖学特点，以及术中预防股外侧皮神经损伤的方法。结果股外侧皮神经损伤是直接前侧入路微创全髋关节置换术常见术中并发症之一，发生率为0．9％～3．4％。通过Heuter间隙所行的全髋关节置换术最符合微创手术的标准，作直接前侧入路皮肤切口分离皮下软组织时常常损伤股外侧皮神经，可以通过改良手术切口位置、精细化手术操作、纵向牵引拉钩及肌间隔穿支动脉这一定位股外侧皮神经的解剖学标志，来降低股外侧皮神经的损伤概率。结论直接前侧入路微创全髋关节置换术与传统全髋关节置换术相比，理论上有较小的软组织损伤，虽然仍会在术中造成股外侧皮神经的损伤，但是存在降低损伤率的方式。Objective To investigate the causes of nerve palsy complications in minimally invasive total hip arthroplasty via a direct anterior approach and its prevention strategy. Methods A computer-based search was conducted in PubMed and CNKI databases for literatures related to minimally invasive total hip arthroplasty via a direct anterior approach from January 2005 to November 2016 with the key words ＂direct anterior approach＂, ＂lateral femoral cutaneous nerve＂ in English and ＂直接前侧入路＂, ＂股外侧皮神经＂ in Chinese. As a result, 28 articles were carefully reviewed. Analysis was conducted for the anatomical features of direct anterior approach, Hueter interval and lateral femoral cutaneous nerve as well as the prevention strategies for never injury based on the selected articles. Results Lateral femoral cutaneous nerve injury is one of common complications of direct anterior approach for total hip replacement, and the incidence is between 0. 9% - 3.4%. Total hip arthroplasty through the Hueter interval is the fittest procedure, which meet the standard of minimally invasive surgery. Unfortunately, lateral femoral cutaneous nerve is constantly injuried during splitting subcutaneous soft tissue when skin incision is carried. To alleviate the injury to the lateral femoral cutaneous nerve, surgeons can choose suitable incision location, make surgical procedures exquisite, pull the retractor in a longitudinal direction, and locate the intermuscular septum perforating branches. Conclusions Compared with traditional total hip arthroplasty, direct anterior approach has less soft tissue injury theoretically, and, meanwhile, there are prevention strategies to alleviate lateral femoral cutaneous nerve injuries which occur in this surgical procedures.

关 键 词：关节成形术 置换 髋 直接前侧入路 微创 股外侧皮神经损伤 预防 

分 类 号：R687.4[医药卫生—骨科学]