髋关节前外侧入路----Watson-Jones切口精编版

1、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

2、 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

3、 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 anterio

4、rly 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7-10c

5、m 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）。13、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。24、深层分离With the greater trochante

6、r 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 v

7、essels 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。35、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 dissecte

8、d 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。46、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

9、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。57、打开关节囊Make an T-shaped incision in the capsule,关节囊做一个 T 型切口68、打开关节囊and place two retractionsutures, anteriorly and posteriorly. Protect

10、 the acetabularlabrum.This capsulotomy shows the anterior femoral head and neck. Lateral traction and repositioning of the leg can improve visualization.The incison can be prolonged distally over the proximal vastus lateralis to allow insertion of screws or DHS for femoral neck fracture fixation.在关节

11、囊前方和后方置入两根缝合线，以保护髋臼。此关节囊切开术可以显露股骨头和颈前面，外侧牵开或旋转大腿可以增加显露。此切口可以沿股外侧肌延长，以便拧入股骨颈螺钉或DHS 来固定股骨颈骨折。79、闭合伤口Perform a meticulous debridement of all soft tissues before starting wound closure. Remove necrotic tissue and irrigate the entire wound to decrease the risk of periarticular ossification. Insert suction drains if desired.Close