髖關(guān)節(jié)前外側(cè)入路_Watson_Jones切口

1、1、術(shù)前準(zhǔn)備The an terolateral approach (Wats on-Jon es) to the proximal femur, through the in tervalbetwee n glutei and ten sor fascia lata provides somewhat limited access to the hip joi nt alongwith the lateral proximal femur. With well-positi oned retractors and adequate soft-tissuereleases, it is pos

2、sible 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 join t (Iliofemoral or Smith-Peters on), medial to the ten sorfascia lata, may improve access to the femoral head and neck, but for fixation of the nec

3、kwith 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(guò)臀肌與闊筋膜張肌之間有限顯露髖 關(guān)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(lái)復(fù)位 股骨頸骨折(31-b)，有時(shí)也可以復(fù)位些股骨頭骨折(31-C )。一個(gè)更靠?jī)?nèi)側(cè)顯露髖關(guān)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(gè)獨(dú)立的外側(cè)切口。2、皮膚切口Start the slightly anteriorly

4、 curved skin incision about 7-10 cm proximal of the lateral part ofthe greater trocha nter (directed towards the tubercule of the iliac crest-the posteriorlandmark of tensor fascia lata origin). Distally, the incision extends along the femur about 10 cm below the greater trocha nter.在股骨大轉(zhuǎn)子上約7-10cm外側(cè)

5、略前方處行輕微彎曲皮膚切口（方向從髂結(jié)節(jié)3、顯露闊筋膜張肌Expose the fascia lata sharply .In cise the fascia lata over the femur and exte nd this in cisi on 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 trocha nter and the gluteus medius muscle ex

6、posed, retract the ten sor fascialata anteriorly and the gluteus medius muscle posteriorly. Expose the interval between thegluteus medius and the ten sor fascia lata and exte nd it proximally over the hip joint. This can be best done by blu nt dissecti on.Be aware of vessels running across this inte

7、rval. 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(guān)節(jié)。注意此間隙的血管術(shù)，可以結(jié)扎或電凝止血。Anterolateral approach5、顯露髖關(guān)節(jié)囊Place a Hohma nn retractor into the bone proximal to the hip capsule. Additi onal retractors anteriorly and posteriorly will open the dissected interval.

8、External rotation of the leg improves access to the hip capsule.在髖關(guān)節(jié)股骨頭部放置Hohmann拉鉤，另外在前和后方各放置一個(gè)拉鉤，可 以顯露解剖間隙。外旋大腿將有助于顯露髖關(guān)節(jié)囊Anterolateral approachSuperior gluteal nerve Superior gluteal vessels Rectus ferrorisIliopsoasGluteus minimusGluteus mediijsPSVastus lateral isTrocha ntei匚 bursaPirifornnis-ilio

9、psoasGluteus medium6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 n ecessary, and debride periarticular fat to expose the hip capsule.從大轉(zhuǎn)子前

10、下方剝離股外側(cè)肌起點(diǎn)顯露潛在的關(guān)節(jié)囊，向下牽拉肌肉視需要調(diào)整拉鉤，清除關(guān)節(jié)周圍的脂肪Anterolateral approachSuperior gluteal nerve Superior gluteaf Rectus fem orisvesselsHiofemoral ligamentGluteus minimsVastus lateralisTrochanteric bursa7、打開關(guān)節(jié)囊Make an T- shaped incision in the capsule,關(guān)節(jié)囊做一個(gè)T型切口AnteroMteral approachSuperior glutealRectum femo

11、ris IliopsoasGluteus minimusVastus laterdlisdiofemoral ligamentGluteus mediu?Trochanteric bursa8、打開關(guān)節(jié)囊and place two retractionsutures, anteriorly and posteriorly. Protect the acetabular labrum.This capsulotomy shows the anterior femoral head and neck. Lateral traction and repositi oning of the leg c

12、an improve visualizati on.The in cis on can be pro lon ged distally over the proximal vastus lateralis to allow in serti on of screws or DHS for femoral n eck fracture fixati on.在關(guān)節(jié)囊前方和后方置入兩根縫合線，以保護(hù)髖臼。此關(guān)節(jié)囊切開術(shù)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(zhǎng)，以便擰入股骨頸螺釘或DHS來(lái)固定股骨頸骨折Superior glutea In erve Superi

13、orRectus femorisGluteus minimusGluteus mediumGluteus medju5HTrochanteric bursa9、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 periarticularossificati on .In sert sucti on drains if desired.Close the fascia lata incision with interrupted sutures. Close the subcutaneous tissue and skinas desired.閉合傷口前仔細(xì)清除所有軟組織。清除壞死組織并沖洗整個(gè)傷口以減少