股外侧皮神经的手术安全区与前侧入路微创全髋关节置换术切口的选择

Surgery safe zone of later femoral cutaneous nerve region and skin incision choice of minimally invasive surgery of total hip arthroplasty with anterior surgery approach

目的探讨股外侧皮神经的手术安全区和前侧入路微创全髋关节置换手术切口的选择。方法解剖23具成年尸体标本（46髋），记录股外侧皮神经（LFCN）的走向，分支及与周围解剖标志的距离；统计标示出股外侧皮神经的手术风险区和安全区。结果28.3%的股外侧皮神经在穿过腹股沟韧带下方前有分支，最多4支；LFCN手术风险区为出骨盆处沿腹股沟韧带方向距髂前上棘（ASIS）距离范围为6-71mm；LFCN沿缝匠肌方向穿出缝匠肌外缘处距ASIS距离范围为21-112mm；LFCN出缝匠肌外侧缘处水平垂直于ASIS垂线的距离范围为1-35mm。结论相对于股外侧皮神经的安全区，微创前侧入路MIS-THA前侧位于髂前上棘下方偏向外侧的皮肤切口更为安全，同时具有更便宜的扩展性。

Objective To indentify surgery safe zone of later femoral cutaneous nerve and skin incision choice of of minimally invasive surgery of total hip arthroplasty with anterior surgery approach. Methods 23 adult cadavers （46hips） were used for anatomic research. The course of the later femoral cutaneous nerve （LFCN）was recorded. Surgery danger zone and surgery safe zone of later femoral cutaneous nerve region were indentified by data analysis. Results LFCN were found potentially at risk as far as 6～71 mm medial to anterior superior iliac spine （ASIS） along the inguinal ligament, as much as 21～112 mm distal on the lateral border sartorius muscle from the ASIS. And 1～35 mm distal to the vertical line from ASIS; As many as 4 branches were found branches of the LFCN and in 28.3% cases the LFCN branched before traversing the inguinal ligament. Conclusion The skin incisions distal from ASIS vertical line is in safe zone of LFCN, and easily avoid damage the LFCN; these extensions proximally and distally, full access to the acetabulum and the entire femur can be readily obtained.