全髋关节置换术直接前入路改良切口与股外侧皮神经损伤的解剖学研究  

Anatomical study of modified incision and lateral femoral cutaneous nerve injury with direct anterior approach in total hip arthroplasty

作　　者：周宏博 罗正亮 陈敏[2] 尚希福 陈士文[3] Zhou Hongbo;Luo Zhengliang;Chen Min;Shang Xifu;Chen Shiwen(Department of Orthopedics,Provincial Hospital Affiliated to Anhui Medical University,Hefei 230001,China;Department of Orthopedics,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China;Department of Human Anatomy,Bengbu Medical College,Bengbu 233030,China)

机构地区：[1]安徽医科大学附属省立医院骨科,合肥230001 [2]中国科学技术大学附属第一医院骨科,合肥230001 [3]蚌埠医学院人体解剖学教研室,安徽省蚌埠市233030

出　　处：《中华解剖与临床杂志》2021年第4期387-390,共4页Chinese Journal of Anatomy and Clinics

基　　金：安徽省自然科学基金(1808085QH242)。

摘　　要：目的:探讨全髋关节置换术直接前方入路(DAA)改良切口和经典切口的解剖特点,为术中避免股外侧皮神经(LFCN)损伤提供解剖学依据。方法:由蚌埠医学院解剖教研室提供成年国人尸体髋关节及股骨标本6具6侧,其中男2具2侧、女4具4侧,年龄48~72(61.7±8.2)岁。通过解剖标志定位的方式做DAA手术切口,切口起点均为髂前上棘最高点向下向外3 cm;DAA经典切口延长方向指向腓骨小头;改良切口将切口延长方向向经典切口外后方偏移,偏移角度为髂前上棘最高点分别与腓骨小头、股骨大粗隆顶点连线夹角的1/2。解剖显露LFCN以及所有分支:(1)观察LFCN走行及其与DAA经典切口、DAA改良切口的关系;(2)对LFCN进行分型;(3)测量DAA经典切口和改良切口与LFCN最短距离,判断LFCN与DAA经典切口和改良切口的解剖关系。结果:(1)LFCN由髂前上棘内侧0.8 cm经腹股沟韧带下方走向股骨前方,LFCN走行向前、向外近乎平行于髂前上棘最高点与腓骨小头连线。DAA经典切口远端与LFCN有交叉,有直接损伤LFCN可能,延长DAA经典切口会增加损伤LFCN概率;而DAA改良切口与LFCN无交叉。(2)6侧标本LFCN分型:缝匠肌型3侧,后向型2侧,扇形型1侧。(3)LFCN与DAA改良切口最短距离为1.2~2.4(2.0±0.40)cm,与经典切口最短距离为0~1.4(0.98±0.55)cm。缝匠肌型和后向型LFCN主干及分支与DAA改良切口的最短距离均>2.0 cm;与DAA经典切口无交叉,且LFCN所有分支与DAA改良切口最短距离均>0.7 cm。扇形型LFCN与DAA经典切口有交叉,而与DAA改良切口无交叉,最短距离为1.2 cm。结论:在解剖关系上,DAA改良切口比DAA经典切口距离LFCN更远,DAA全髋关节置换术中更不易发生LFCN损伤。Objective To investigate the anatomical characteristics of modified and classical incisions through the direct anterior approach(DAA)in total hip arthroplasty and to provide an anatomical basis for avoiding the intraoperative injury of the lateral femoral cutaneous nerve(LFCN).Methods The Department of Anatomy of Bengbu Medical College provided six specimens of the hip joint and femur of adult Chinese cadavers,which included two males with two sides and four females with four sides and were aged 48-72(61.7±8.2)years old.The DAA incision was performed via anatomical marker localization,and the starting point of the incision was all downward and outward 3 cm from the highest point of the anterior superior iliac spine.The classical incision in DAA was directed toward the prolongation of the fibular head.The extension direction of the modified incision was shifted outward and backward to the classical incision,and the offset angle was 1/2 of the angle between the highest point of the anterior superior iliac spine and the vertex of the fibula head and the greater trochanter of the femur.The LFCN and all its branches were revealed by anatomy(1)to observe the morphology of the LFCN and its relationship with the classical and modified DAA incisions;(2)to classify the LFCN;and(3)to measure the shortest distance between the classical and modified incisions in DAA and the LFCN to determine the anatomical relationship between the LFCN and the classical and modified incisions in DAA.Results(1)The LFCN moved from the medial 0.8 cm of the anterior superior iliac spine to the anterior femur through the lower part of the inguinal ligament.The LFCN moved forward and outward almost parallel to the connection between the highest point of the anterior superior iliac spine and the fibula microcephalus.The classical DAA incision crossed the LFCN distally;such an approach might directly damage the LFCN.Extending the classical DAA incision will increase the probability of LFCN injury.No crossover occurred between the modified DAA incisi

关 键 词：关节成形术 置换 髋 直接前方入路 改良切口 股外侧皮神经损伤 

分 类 号：R687.4[医药卫生—骨科学] R322.7[医药卫生—外科学]