髋前外侧肌间隙入路治疗股骨转子间骨折的应用解剖

Applied anatomy of anterolateral intermuscular approach for intertrochanteric fracture

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（4．25～6．30cm），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±9．56cm）；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（5．05～6．62cm）。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。

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.