髋关节直接前入路切口远端延长相关应用解剖学研究

摘要

Objective To provide an anatomical basis for the distal extension of direct anterior approach and its surrounding vulnerable structures in the hip.Methods Ten adult cadaveric lower extremities were dissected to observe anatomical structures of significant nerves and vascularities according to the operational process.Results The distances from the lateral branch of the lateral femoral cutaneous nerve to the incision on X1,X2,X3 plane were 0.61 ± 0.39,-0.65 ± 0.39,-0.10 ± 0.32cm,respectivley,the distances from the medial branch of the lateral femoral cutaneous nerve to the incision on X1,X2,X3 plane were 1.53 ± 0.52,0.67 ± 0.56,1.28 ± 0.56cm,respectively.The distances from the intersections of the branches of the lateral femoral circumflex artery (ascending,transverse and descending) with the incision to ASIS were 7.77 ± 0.79,11.01 ± 1.48,14.91 ± 1.48cm,respectively,the distances from the intersections of the branches of the lateral femoral circumflex artery (ascending,transverse and descending) with the incision to X1 plane were 0.48 ± 0.58,4.99 ± 1.18,7.35 ± 1.07cm,respectively.The distances from the entrance points of nerve branches of the vastus lateralis(the proximal one and the distal one) to ASIS were 11.26 ± 0.96,15.09 ± 1.74cm,respectivley,the distances from the entrance points of nerve branches of the vastus lateralis (the proximal one and the distal one) to X1 plane were 4.70 ± 2.09,7.71 ± 1.45cm,respectively.Conclusion The area distal to the intertrochanteric line is a common entry point for several nerve branches.The distal extension of the direct anterior approach should not exceed 1.1cm under the plane of the great trochanter.%目的 为髋关节直接前入路远端延长及其易损伤结构提供解剖学依据.方法 参照手术入路层次对10个成年尸体下肢标本相关结构和重要的神经血管进行解剖观测.结果 股外侧皮神经外侧支与切口线的距离在X1、X2、X3线平面上分别为(0.61±0.39)、(-0.65±0.39)、(-0.10±0.32)cm,股外侧皮神经内侧支与切口线的距离在X1、X2、X3线平面上分别为(1.53±0.52)、(0.67±0.56)、(1.28±0.56)cm.旋股外侧动脉各分支(升支、横支、降支)与切口线的交点与髂前上棘(ASIS)的距离分别为(7.77±0.79)、(11.01±1.48)、(14.91±1.48)cm,旋股外侧动脉各分支(升支、横支、降支)与切口线的交点与X1线平面的距离分别为(0.48±0.58)、(4.99±1.18)、(7.35±1.07)cm.股神经股外侧肌支分支(最上支、最下支)入肌点与ASIS的距离分别为(11.26±0.96)、(15.09±1.74)cm,股神经股外侧肌支分支(最上支、最下支)入肌点与X1线的距离分别为(4.70±2.09)、(7.71±1.45)cm.结论 转子间线的远端是许多神经分支的入点,髋关节直接前入路切口的远端延长不应超过大转子平面以下1.1cm.