髋关节手术入路的解剖学基础
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1.Lateral incision centered over greater trochanter. 2.Gluteus medius tendon elevated from posterior border; vastus lateralis split in middle; both subperiosteally elevated and displaced anteriorly. 3.Gluteus minimus transected at insertion and retracted superiorly. 4.Hip dislocated posteriorly.
2.Split tensor longitudinally in anteromedial portion. 3.Release of tensor origin and posterior capsule release
ioptional/ 4.Trochanteric osteotomy optional.
Approach
wenku.baidu.com
Description
Technique
Anterior
Fahey(1949)21
1.Staight incision from ASIS to region below trochanter
2.Intermuscular interval between tensor and sartorius
Approach Direct lateral
Description Dall(1986)18
McFarlandOsborne(1954)57
Technique
1.Hardinge incision. 2.Gluteus medius and vastus lateralis longitudinally split in line with femral shaft; gluteus minimus identified. 3.Partial anterior trochanteric osteotomy. 4.Trochanteric wafer displaced anterior and medial in continuity with gluteus medius and vastus lateralis. 5.Hip dislocated anteriorly.
3.Transect straight head of rectus..
4.Trochanteric osteotomy optional.
Light-Keggi(1980)48 1.Curved incision from ASIS to tip of greater
trochanter(Fig.37-10).
WatsonJones(1936)87
1.Posterior curved incision from midpoint of line connecting ASIS and greater trochanter curved around tip of trochanter along the posterior border of femoral shaft
2.Intermuscular interval between tensor and sartorius.
3.Osteotomy of spines and trochanter
Approach
Anterolate ral
Description
BurwellScott(1954)10
Technique
1.Curved incision 1 inch inferior and posterior to ASIS to point 3 inches distal to greater trochanter in line with femoral shaft
2. Intermuscular interval between tensor and gluteus medius.
1.Curved incision from point 3 inches anterior to PSIS and along anterior femoral border 2.Intermuscular interval between tensor and gluteus medius.
Muller(1970)63
Approach Anterior
Description
Technique
Smith-
1.Curved incision along anterior half of ilium to ASIS
Petersen(1917)78
and carried distally 12to 15cm
2.Intermuscular interval between tensor and sartorius.
2.Intermuscular interval between tensor and gluteus medius.
3.Transverse division of anterior gluteus medius insertion
4.Trochanteric osteotomy optional.
3.Ostetomy of ASIS
4.Strip gluteus medius, minimus, and tensor from
ilium.
5. Trochanteric osteotomy possible
SutherlandRowe(1944)80
1. Curved incision from ASIS to greater then distally in line with femoal shaft
Luck(1955)32
1.Incision from midportion between ASIS and symphysis to region lateral to greater trochanter
2.Transect tensor in distal third. 3.Trochanteric osteotomy optional.
2.Split tensor longitudinally in anteromedial portion. 3.Release of tensor origin and posterior capsule release
ioptional/ 4.Trochanteric osteotomy optional.
Approach
wenku.baidu.com
Description
Technique
Anterior
Fahey(1949)21
1.Staight incision from ASIS to region below trochanter
2.Intermuscular interval between tensor and sartorius
Approach Direct lateral
Description Dall(1986)18
McFarlandOsborne(1954)57
Technique
1.Hardinge incision. 2.Gluteus medius and vastus lateralis longitudinally split in line with femral shaft; gluteus minimus identified. 3.Partial anterior trochanteric osteotomy. 4.Trochanteric wafer displaced anterior and medial in continuity with gluteus medius and vastus lateralis. 5.Hip dislocated anteriorly.
3.Transect straight head of rectus..
4.Trochanteric osteotomy optional.
Light-Keggi(1980)48 1.Curved incision from ASIS to tip of greater
trochanter(Fig.37-10).
WatsonJones(1936)87
1.Posterior curved incision from midpoint of line connecting ASIS and greater trochanter curved around tip of trochanter along the posterior border of femoral shaft
2.Intermuscular interval between tensor and sartorius.
3.Osteotomy of spines and trochanter
Approach
Anterolate ral
Description
BurwellScott(1954)10
Technique
1.Curved incision 1 inch inferior and posterior to ASIS to point 3 inches distal to greater trochanter in line with femoral shaft
2. Intermuscular interval between tensor and gluteus medius.
1.Curved incision from point 3 inches anterior to PSIS and along anterior femoral border 2.Intermuscular interval between tensor and gluteus medius.
Muller(1970)63
Approach Anterior
Description
Technique
Smith-
1.Curved incision along anterior half of ilium to ASIS
Petersen(1917)78
and carried distally 12to 15cm
2.Intermuscular interval between tensor and sartorius.
2.Intermuscular interval between tensor and gluteus medius.
3.Transverse division of anterior gluteus medius insertion
4.Trochanteric osteotomy optional.
3.Ostetomy of ASIS
4.Strip gluteus medius, minimus, and tensor from
ilium.
5. Trochanteric osteotomy possible
SutherlandRowe(1944)80
1. Curved incision from ASIS to greater then distally in line with femoal shaft
Luck(1955)32
1.Incision from midportion between ASIS and symphysis to region lateral to greater trochanter
2.Transect tensor in distal third. 3.Trochanteric osteotomy optional.