髖關節(jié)前外側(cè)入路----Watson-Jones切口.docx

。1、術前準備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.前外側(cè)入路即W-J入路顯露股骨近端，通過臀肌與闊筋膜張肌之間有限顯露髖關節(jié)及股骨近端。在牽開器幫助和充分的軟組織松解的情況下，可以用來復位股骨頸骨折（31-b），有時也可以復位些股骨頭骨折（31-C）。一個更靠內(nèi)側(cè)顯露髖關節(jié)的切口如Iliofemoral切口或S-P切口，在闊筋膜張肌內(nèi)側(cè)，可以提供顯露股骨頭和股骨頸，但是如果用DHS固定股骨頸骨折，則需要一個獨立的外側(cè)切口。2、皮膚切口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.在股骨大轉(zhuǎn)子上約7-10cm外側(cè)略前方處行輕微彎曲皮膚切口（方向從髂結節(jié)到闊筋膜張肌起始部），向遠端延伸至股骨干（大粗隆下10cm處）。3、顯露闊筋膜張肌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.銳性顯露闊筋膜張肌。在股骨處切開闊筋膜張肌并向近端沿著闊筋膜張肌后側(cè)邊界銳性分離。4、深層分離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.顯露大粗隆及臀中肌，將闊筋膜張肌向前方牽開，臀中肌向后方牽開。鈍性分離臀中肌與闊筋膜張肌之間間隙向近端延伸至髖關節(jié)。注意此間隙的血管術，可以結扎或電凝止血。5、顯露髖關節(jié)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.在髖關節(jié)股骨頭部放置Hohmann拉鉤，另外在前和后方各放置一個拉鉤， 可以顯露解剖間隙。外旋大腿將有助于顯露髖關節(jié)囊。6、松解股外側(cè)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.從大轉(zhuǎn)子前下方剝離股外側(cè)肌起點顯露潛在的關節(jié)囊，向下牽拉肌肉。視需要調(diào)整拉鉤，清除關節(jié)周圍的脂肪。7、打開關節(jié)囊Make an T-shaped incision in the capsule, 關節(jié)囊做一個T型切口8、打開關節(jié)囊and place two retraction sutures, anteriorly and posteriorly. Protect the acetabular labrum.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.在關節(jié)囊前方和后方置入兩根縫合線，以保護髖臼。此關節(jié)囊切開術可以顯露股骨頭和頸前面，外側(cè)牽開或旋轉(zhuǎn)大腿可以增加顯露。此切口可以沿股外側(cè)肌延長，以便擰入股骨頸螺釘或DHS來固定股骨頸骨折。9、閉合傷口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 the fascia lata incision with interrupted sutures.