髋关节外侧入路安全区的解剖定位与临床应用

The Dissection, Position and Clinical Practice of the Safety Region of the Lateral Approach of Hip Joint

目的 为髋关节直接外侧入路确定臀上神经最下支的体表投影和手术安全区。方法 在 46侧无下肢疾患的成人尸体标本上 ,解剖定位臀上神经最下支的体表投影 ,并在临床进行应用。结果 手术入路的安全区为①术前 :以大转子外铡最凸点为圆点 ,该点与髂嵴垂直连线上的 9cm处为半径作一弧线 ,该线即为臀上神经最下支的体表投影 ,弧线与大转子外侧最凸点之间的扇形区域即为安全区。②术中 :以大转子尖为圆心 ,该点与髂嵴垂直连线上的 5cm处为半径作一弧线 ,弧线与大转子尖的扇形区域为安全区。结论 安全区内无重要血管神经分布 ,在此区内撑开臀中、小肌肌纤维显露髋臼不会损伤臀上神经。临床应用 2 0 0余例 ,均未发生髋关节外展功能障碍 。

Objective To determine the surface projection and operative safe region of the lowest branch of superior gluteus nerve for the hip joint direct lateral approach. Methods dissecting and positioning of the surface projection of the lowest branch of the superior gluteus nerve on 46 sides adult cadavers without leg diseases and applying it to clinical practice. Results The safe region of the operative route is: ① before the operation, we draw a circle with the lateral protrusive point of the trochanter major as its center and the distance from this point to the 9cm point on the vertical line of crista iliaca as its radius. This circle is the surface projection of the lowest branch of superior gluteus nerve and the fan-shaped region between the circle and lateral protrusive point of trochanter major is the safe region. ② during the operation, we draw a circle with the top point of the trochanter major as its centre and the distance from this point to the 5cm point on the vertical line of crista iliaca as its radius. The fan-shaped region between the circle and the top point of the trochanter major is the safe region. Conclusion No major blood vessels and nerve branches are distributed in the safe region. The superior gluteus nerve will not be injured if you open the M.glutaeus medius and M. glutaeus mininus fibre to make the acetabulum visible in this region. No functional disorder of the hip joint was observed in more than 200 cases in clinical practice.