髋关节手术入路的解剖学基础医学课件教学课件

1、Surgical Approaches to the Hip of Hip Arthroplasty2021/7/912021/7/922021/7/932021/7/942021/7/952021/7/962021/7/972021/7/982021/7/992021/7/9109、 人的价值，在招收诱惑的一瞬间被决定。2022/7/152022/7/15Friday, July 15, 202210、低头要有勇气，抬头要有低气。2022/7/152022/7/152022/7/157/15/2022 7:52:45 PM11、人总是珍惜为得到。2022/7/152022/7/152022/

2、7/15Jul-2215-Jul-2212、人乱于心，不宽余请。2022/7/152022/7/152022/7/15Friday, July 15, 202213、生气是拿别人做错的事来惩罚自己。2022/7/152022/7/152022/7/152022/7/157/15/202214、抱最大的希望，作最大的努力。15 七月 20222022/7/152022/7/152022/7/1515、一个人炫耀什么，说明他内心缺少什么。七月 222022/7/152022/7/152022/7/157/15/202216、业余生活要有意义，不要越轨。2022/7/152022/7/1515 Ju

3、ly 202217、一个人即使已登上顶峰，也仍要自强不息。2022/7/152022/7/152022/7/152022/7/152021/7/9112021/7/9129、 人的价值，在招收诱惑的一瞬间被决定。2022/7/152022/7/15Friday, July 15, 202210、低头要有勇气，抬头要有低气。2022/7/152022/7/152022/7/157/15/2022 7:52:45 PM11、人总是珍惜为得到。2022/7/152022/7/152022/7/15Jul-2215-Jul-2212、人乱于心，不宽余请。2022/7/152022/7/152022/7

4、/15Friday, July 15, 202213、生气是拿别人做错的事来惩罚自己。2022/7/152022/7/152022/7/152022/7/157/15/202214、抱最大的希望，作最大的努力。15 七月 20222022/7/152022/7/152022/7/1515、一个人炫耀什么，说明他内心缺少什么。七月 222022/7/152022/7/152022/7/157/15/202216、业余生活要有意义，不要越轨。2022/7/152022/7/1515 July 202217、一个人即使已登上顶峰，也仍要自强不息。2022/7/152022/7/152022/7/15

5、2022/7/152021/7/9132021/7/9142021/7/9152021/7/9162021/7/9172021/7/9182021/7/9192021/7/9202021/7/9212021/7/9222021/7/9232021/7/9242021/7/9252021/7/9262021/7/9272021/7/9282021/7/9292021/7/930ApproachDescriptionTechniqueAnterior Fahey(1949)211.Staight incision from ASIS to region below trochanter2.Inte

6、rmuscular interval between tensor and sartorius3.Transect straight head of rectus.4.Trochanteric osteotomy optional.Light-Keggi(1980)481.Curved incision from ASIS to tip of greater trochanter(Fig.37-10).2.Split tensor longitudinally in anteromedial portion.3.Release of tensor origin and posterior ca

7、psule release ioptional/4.Trochanteric osteotomy optional.Luck(1955)321.Incision from midportion between ASIS and symphysis to region lateral to greater trochanter 2.Transect tensor in distal third.3.Trochanteric osteotomy optional.2021/7/931ApproachDescriptionTechniqueAnterior Smith-Petersen(1917)7

8、81.Curved incision along anterior half of ilium to ASIS and carried distally 12to 15cm2.Intermuscular interval between tensor and sartorius.3.Ostetomy of ASIS4.Strip gluteus medius, minimus, and tensor from ilium.5. Trochanteric osteotomy possibleSutherland-Rowe(1944)801. Curved incision from ASIS t

9、o greater then distally in line with femoal shaft2.Intermuscular interval between tensor and sartorius.3.Osteotomy of spines and trochanter2021/7/932ApproachDescriptionTechniqueAnterolateralBurwell-Scott(1954)101.Curved incision from point 3 inches anterior to PSIS and along anterior femoral border2

10、.Intermuscular interval between tensor and gluteus medius.Muller(1970)631.Posterior curved incision from midpoint of line connecting ASIS and greater trochanter curved around tip of trochanter along the posterior border of femoral shaft2.Intermuscular interval between tensor and gluteus medius.3.Tra

11、nsverse division of anterior gluteus medius insertion4.Trochanteric osteotomy optional.Watson-Jones(1936)871.Curved incision 1 inch inferior and posterior to ASIS to point 3 inches distal to greater trochanter in line with femoral shaft2. Intermuscular interval between tensor and gluteus medius.2021

12、/7/933ApproachDescriptionTechniqueDirect lateralDall(1986)181.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

13、with gluteus medius and vastus lateralis.5.Hip dislocated anteriorly.McFarland-Osborne(1954)571.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

14、 minimus transected at insertion and retracted superiorly.4.Hip dislocated posteriorly.2021/7/934ApproachDescriptionTechniqueDirect lateralHardinge(1982)291.Lateral incision centered over greater trochanter; extend distally in line with femoral shaft 8cm; Proximal extension directed posteriorly2.Ili

15、otibial band split between gluteus maximus and tensor.3.Anterior half gluteus medius and vastus lateralis elevated subperiosteally and in continuity.4.Hip dislocated anteriorlyStracathro(1984)581.Lateral incision centered over greater trochanter2.Gluteus medius tendon and vastus lateralis incised in

16、 line with femoral shaft; gluteus minimus identified.3.Anterior partial trochanteric osteotomy and posterior partial trochanteric osteotomy.4.Trochanteric wafers with gluteus medius and astus lateralis portions displaced anteriorly and posteriorly5.Hip dislocated anteriorly and posteriorly.2021/7/93

17、5ApproachDescriptionTechniqueTranstrochantericHarris(1967)311.U-shaped incision2.Fascia lata incised in line with incision;relaxing incision made in posterior fascia lata.3.Origin of vastus lateralis elevated; trochanteric osteotomy from vastus lateralis tubercle to region between gluteus minimus an

18、d gluteus medius insertions.4.Short external rotators divided.5.Hip dislocated anteriorly and posteriorly. Jergeson-Abbott(1955)411.Lazy S incision2.Iliotibial band is split in line with incision.3.Trochanteric osteotomy.4.Short external rotators divided.5.Portion of gluteus maximus insertion may be

19、 incised.6.Hip may be dislocated anteriorly or posteriorly.2021/7/936ApproachDescriptionTechniquePosterior Iyer(1981)401.Curved posterior incision.2.Iliotibial band split in line with the skin incision.3.Gluteus maximus split in middle third.4.Trochanteric osteotomy at junction of posterior third,di

20、rected caudad, and posteriorly to a point just distal to quadrate tubercle. Hip dislocated posteriorly. Moore(1957)601.Skin incision2.See text for description.2021/7/937ApproachDescriptionTechniqueCombined approachesAnterior trochanteric slide(1987)261.Incision centered over the femoral shaft with p

21、roximal extension from the anterior border of the greater trochanter in line with the fibers of the underlying gluteus maximus.2.Gluteus medius identified at anterior and posterior borders separated from underlying gluteus minimus.3.Vastus lateralis elevated subperiosteally from anterior and lateral

22、 femoral shaft.4.Trochanteric osteotomy in the sagittal polane just medial to the gluteus medius insertion extended to point below the vastus lateralis tubercle.5.Short external rotators divided.Extensile exposure(1987)351.Incision centered over the femoral shaft and extends proximally with gentle p

23、osterior curve.2.Entire vastus lateralis subperiosteally elevated from posteriorly to anteriorly.3.Anterior gluteus medius and minimus removed in continuity with vastus lateralis with an underlying bone wafer.2021/7/938ApproachDescriptionTechniqueCombined approachesTriradiate exposure(1988)471.Trira

24、diate incision with equal angles between the limb centered over the prominence of the greater trochanter2.Standard anterolateral and posterior capsule exposures performed.3.Hip dislocated either anteriorly or posteriorly.Tronzo(1969)821.Incision centered over the greater trochanter extending and equ

25、al distance above and below.2.Fascia lata cut long the leading edge of the gluteus maximus.3.Short external rotators and the upper quarter of the quadratus femoris detached. The proximal portion of the gluteus maximus tendon severed.4.Anterior approach between tensor fascia-gluteus medius interval w

26、ith or without detachment of anterior fibers of the gluteus medius.5.Trochanteric osteotomy optional.2021/7/9392021/7/9402021/7/9412021/7/9422021/7/9432021/7/9442021/7/9452021/7/9462021/7/9472021/7/9482021/7/9492021/7/9502021/7/9512021/7/9522021/7/9532021/7/9542021/7/9552021/7/9562021/7/9572021/7/9582021/7/9592021/7/9602021/7/96