髋前外侧肌间隙入路治疗股骨转子间骨折的应用解剖
收稿日期: 2013-08-02
网络出版日期: 2014-04-21
Applied anatomy of anterolateral intermuscular approach for intertrochanteric fracture
Received date: 2013-08-02
Online published: 2014-04-21
目的 为髋前外侧肌间隙手术入路治疗股骨转子间骨折提供解剖学基础。 方法 12侧成人尸体下肢标本，模拟髋前外侧肌间隙入路对相关结构和神经血管进行解剖观测。 结果 臀中肌阔筋膜张肌间隙髂嵴附着处距髂前上棘距离（5.13±0.52）cm(4.25~6.30 cm），在该间隙内常见臀上神经最下支以及旋股外侧动脉升支臀中肌支穿过，臀上神经最下支穿臀中肌阔筋膜张肌间隙处至股骨大转子外侧最凸点距离为（8.15±0.67）cm(7.13~9.56 cm）；旋股外侧动脉升支臀中肌支走行至该间隙处距离股骨大转子外侧最凸点距离为（5.57±0.39）cm(5.05~6.62 cm）。 结论 髋前外侧肌间隙入路治疗股骨转子间骨折具有安全、暴露充分、软组织损伤小等特点，为股骨转子间骨折的手术治疗提供了新思路和新方法。
李斌华 , 戴闽 , 丁志辉 , 张斌 , 周祝建 . 髋前外侧肌间隙入路治疗股骨转子间骨折的应用解剖[J]. 中国临床解剖学杂志, 2014 , 32(2) : 125 -128 . DOI: 10.13418/j.issn.1001-165x.2014
Objective To provide anatomic basis for treating intertrochanteric fracture through anterolateral intermuscular approach to hip joint. Methods 12 adult cadaveric lower extremities were dissected to observe anatomical structures of relative nerves and vascularure according to the operational process. Results The distance from the intermuscular septum between gluteus medius and tensor fasciae latae to the anterior superior iliac spine was(5.13±0.52) cm(4.25~6.30 cm). the most inferior branch of the superior gluteal nerve and the gluteus medius branches of the lateral femoral circumflex artery often traveled across the intermuscular septum. The distance from the most inferior branch of superior gluteal nerve in the spatium intermuscular to the lateral protrusive point of greater trochanter was (8.15±0.67)cm (7.13~9.56 cm); and the distance from the gluteus medius branches of the lateral femoral circumflex artery in the intermuscular septum to the lateral protrusive point of the greater trochanter was (5.57±0.39)cm (5.05~6.62 cm). Conclusions The anterolateral intermuscular approach to the hip joint, which is safe, creates full exposure and imposes less damage, provides a new thinking and method for surgical treatment of the intertrochanteric fracture.
[1] Sadowski C,Lubbeke A,Saudan M,et al. Treatment of reverse oblique and transverse intertrochanteric fractures with use of an interamedullary nail or a 95°screw-plate:a prospective,randomized study
[J]. J Bone Joint Surg Am, 2002,84(3):372-381.
[2] Evans EM. The treatment of trochanteric fractures of the femur
[J]. J Bone Joint Surg Br, 1949,31(2):190-203.
[3] Jensen JS, Tondevold E, Sonne-Holm S. Stable trochanteric fractures,a comparative analysis of four methods of internal fixation
[J]. Acta Orthop Scand, 1980, 51(5):811-816.
[4] 于德富，王栋，许东伟．股骨粗隆间骨折手术治疗比较( 附173例报告［J］．中国骨与关节损伤杂志, 2007, 22( 6): 514-515．
[5] 戴闽,邹帆, 张斌, 等. 改良髋前外侧入路与髋外侧入路治疗老年股骨粗隆间骨折疗效比较
[J]. 中国修复重建外科杂志, 2012, 26(8): 910-914.
[6] 吴炳华, 邹帆, 李斌华, 等. 改良前外侧肌间隙入路联合动力髋螺钉治疗股骨粗隆间骨折的疗效
[J]. 广东医学, 2013, 34(8): 1186-1189.
[7] Bertin KC, Rottinger H. Anterolateral mini-incision hip replacement surgery: a modified Watson-Jones approach
[J]. Clin Orthop Relat Res, 2004,(429):248-255.
[8] 陈玲珑, 兰金宝. 臀上神经最下支的解剖定位及在全髋关节外侧入路中意义
[J]. 中国临床解剖学杂志, 1995, 13(4): 255-257.
[9] 秦啸龙, 张先龙, 周国民. 前外侧肌间隙手术入路微创全髋关节置换术应用解剖学研究
[J]. 中国临床解剖学杂志, 2008, 26(3): 255-258.
[10] Lavigne P, Loriot de Rouvray TH. The superior gluteal nerve. Anatomical study of its extrapelvic portion and surgical resolution by trans-gluteal approach
[J]. Rev Chir Orthop Reparatrice Appar Mot,1994, 80(3):188-195.
[11] 赵德伟, 徐达传, 马岩, 等. 旋股外侧血管升支臀中肌支大转子骨瓣转移的应用解剖
[J]. 中华显微外科杂志, 2004, 27(2): 129-131.
[12] 赵德伟, 张耀,徐 达传, 等. 旋股外侧动脉横支联合臀中肌支大转子骨膜瓣的应用解剖
[J]. 中国临床解剖学杂志, 2005, 23(3):234-236.
[13] Wang B, Zhao D, Liu B, Wang W. Treatment of osteonecrosis of the femoral head by using the greater trochanteric bone flap with double vascular pedicles
[J]. Microsurgery, 2013,33:593-599.
[14] 陈振光, 张发惠, 徐达传, 等. 旋股外侧血管升支臀中肌支的解剖学观测及其临床应用
[J]. 中国临床解剖学杂志, 2002, 20(6): 408-409.
[15] 陈振光, 徐达传. 旋股外侧血管升支髂骨瓣的解剖与临床研究
[J]. 中国临床解剖学杂志, 2003, 21(6): 543-544.
[16] Harris B, Owen JR, Wayne JS, et al. Does femoral component loosening poredispose to femoral fracture? an in vitro comparison of cemented hips
[J]. Clin Orthop Relat Res, 2010,468(2):497-503.
[17] 邹帆, 戴闽. 早期运动康复对下肢骨折治疗的临床意义
[J]. 中国矫形外科杂志, 2011, 19(24): 2065-2068.
[18] Kijowski R, Gold GE. Routine 3D magnetic resonance imaging of joints
[J]. J Magn Reson Imaging, 2011,33(4):758-771.
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