髋关节前外侧入路_Watson_Jones切口

1、术前准备

The anterolateral approach (Watson-Jones) to the proximal femur, through the interval between glutei and tensor fascia lata provides somewhat limited access to the hip joint along with the lateral proximal femur. With well-positioned retractors and adequate soft-tissue releases, it is possible to perform open reduction of displaced femoral neck fractures (31-B), and some femoral head fractures (31-C).

A more medial approach to the hip joint (Iliofemoral or Smith-Peterson), medial to the tensor fascia lata, may improve access to the femoral head and neck, but for fixation of the neck with a sliding hip screw, a separate lateral incision will be required.

前外侧入路即W-J入路显露股骨近端，通过臀肌与阔筋膜张肌之间有限显露髋关节及股骨近端。在牵开器帮助和充分的软组织松解的情况下，可以用来复位股骨颈骨折（31-b），有时也可以复位些股骨头骨折（31-C）。

一个更靠内侧显露髋关节的切口如Iliofemoral 切口或S-P切口，在阔筋膜张肌内侧，可以提供显露股骨头和股骨颈，但是如果用DHS固定股骨颈骨折，则需要一个独立的外侧切口。

2、皮肤切口

Start the slightly anteriorly curved skin incision about 7-10 cm proximal of the lateral part of the greater trochanter (directed towards the tubercule of the iliac crest – the posterior landmark of tensor fascia lata origin). Distally, the incision extends along the femur about 10 cm below the greater trochanter.

在股骨大转子上约7-10cm外侧略前方处行轻微弯曲皮肤切口（方向从髂结节到阔筋膜张肌起始部），向远端延伸至股骨干（大粗隆下10cm处）。

3、显露阔筋膜张肌

Expose the fascia lata sharply. Incise the fascia lata over the femur and extend this incision proximally along the posterior border of the tensor fascia lata.

锐性显露阔筋膜张肌。在股骨处切开阔筋膜张肌并向近端沿着阔筋膜张肌后侧边界锐性分离。

4、深层分离

With the greater trochanter and the gluteus medius muscle exposed, retract the tensor fascia lata anteriorly and the gluteus medius muscle posteriorly. Expose the interval between the

gluteus medius and the tensor fascia lata and extend it proximally over the hip joint. This can be best done by blunt dissection.

Be aware of vessels running across this interval. They require ligation or cautery.

显露大粗隆及臀中肌，将阔筋膜张肌向前方牵开，臀中肌向后方牵开。钝性分离臀中肌与阔筋膜张肌之间间隙向近端延伸至髋关节。注意此间隙的血管术，可以结扎或电凝止血。

5、显露髋关节囊

Place a Hohmann retractor into the bone proximal to the hip capsule. Additional retractors anteriorly and posteriorly will open the dissected interval.

External rotation of the leg improves access to the hip capsule.

在髋关节股骨头部放置Hohmann拉钩，另外在前和后方各放置一个拉钩，可以显露解剖间隙。

外旋大腿将有助于显露髋关节囊。

6、松解股外侧肌

The origin of the vastus lateralis muscle should be released from the anterior inferior trochanteric region to expose the underlying hip capsule. Retract the muscle inferiorly. Adjust the retractors as necessary, and debride periarticular fat to expose the hip capsule. 从大转子前下方剥离股外侧肌起点显露潜在的关节囊，向下牵拉肌肉。

视需要调整拉钩，清除关节周围的脂肪。