髖關(guān)節(jié)后外側(cè)入路

1、1、概述The posterolateral approach to the hip may be done with the patient in lateral decubitus or prone positions. For arthroplasty, a lateral decubitus position is usually chosen.The approach is essentially the same as the Kocher-Langenbeck, but exposure is limited to the hip joint, respecting but no

2、t displaying the sciatic nerve. The femoral attachment of the short external rotators and hip capsule should be repaired toreduce the risk of postoperative dislocation. (Early descriptions of hip arthroplasty through a posterolateral approach suggested excision of the posterior hip capsule.)患者可以側(cè)臥位或

3、俯臥位，對于關(guān)節(jié)置換，通常選擇側(cè)臥位。這個(gè)切口和K-L切口相似，只是有限顯露髖關(guān)節(jié)，不顯露坐骨神經(jīng)。股骨的外旋肌群需要修復(fù)以減少術(shù)后關(guān)節(jié)脫位的風(fēng)險(xiǎn)。2、概述After posterior capsulotomy, the hip is dislocated with internal rotation.后側(cè)關(guān)節(jié)囊切開后，髖關(guān)節(jié)在內(nèi)旋時(shí)脫位。3、體位PositioningThe patient is placed in the lateral decubitus position, with supports to prevent rotation away from true lateral,

4、 and appropriate padding to limit focal pressure.After sterile preparation of the hip region, the involved leg is draped free, to permit full mobility.患者側(cè)臥位，用支架支撐放置選擇，用棉墊踮起防止局部壓迫。中移動(dòng)下肢。整個(gè)下肢都要無菌消毒，以便術(shù)4、皮膚切口Skin incisionOutline all bony landmarks with a sterile marking pen:(1) posterior superior iliac

5、 spine (PSIS)(2) greater trochanter(3) shaft of femurStart the skin incision posterior to the lateral side of the greater trochanter and carry it distally about 6 cm along the femoral axis. Proximally, the incision runs slightly curved towards the PSIS to a point approximately 6 cm proximal to the g

6、reater trochanter.切口標(biāo)志：1. 髂后上棘2. 大轉(zhuǎn)子3.股骨干起自大轉(zhuǎn)子后方向下與股骨干長軸平行（6cm），向上指向掐后上棘(6cm)。5、 分離深筋膜Dissection of fascia lataStraight sharp dissection of the fascia lata and gluteal muscle across the greater trochanter. Incise the fascia lata in line with the skin incision.銳性分離闊筋膜和臀大肌間隙，方向與切口方向一致。6、保護(hù)坐骨神經(jīng)Protecti

7、on of sciatic nerveRetraction of the gluteal muscle flap posteriorly shows short external rotators inserting on femur (at least partially obscured by fat). The sciatic nerve can be palpated posteriorly in the depths of the wound. Its exposure is not necessary foruncomplicat ed hip arthroplasty, but

8、the surgeon should be aware of the nerve s location, and avoid injuring it with retractors.向后方牽開臀大肌顯露外旋肌群在股骨的止點(diǎn)（部分被脂肪墊掩蓋） 。坐骨神經(jīng)可以在傷口深處的后方觸及。 在不復(fù)雜的髖關(guān)節(jié)時(shí)不必顯露， 但是外科醫(yī)生應(yīng)意識到神經(jīng)的位置，應(yīng)避免牽拉損傷 。7、切開外旋肌Exposure of short rotator tendonsBluntly dissect the tendinous insertions of the short external rotators. Before

9、dividing the tendons, place heavy, nonabsorbable stay sutures for retraction and subsequent repair. One suture can be placed in the piriformis tendon, and the other in the conjoined tendons of obturator internus and gemelli.鈍性剝離外旋肌腱，在分離肌腱之前，在肌腱上用粗不可吸收線縫合以備牽拉或修復(fù)縫合用。梨狀肌，閉孔肌，gemelli。8、牽開外旋肌Divide and r

10、eflect short rotatorsReflection of the short rotator muscles exposes the hip capsule. Next, enter the joint with a broad-based, 3-sided capsulotomy as shown. Preserve the acetabular labrum, unless total hip arthroplasty is intended.牽開外旋肌，顯露關(guān)節(jié)囊，用寬拉鉤保護(hù)髖臼，除非準(zhǔn)備關(guān)節(jié)置換。9、顯露ExposureExpose the hip joint by cr

11、eating and reflecting a full thickness, broad-based flap of the posterior hip capsule. Heavy (e.g. #2) non-absorbable sutures in its free corners aid retraction and subsequent repair.同上10 、閉合創(chuàng)口ClosureAt the completion ofthe procedure, the posterior capsular flap sutures, and thenthe tendon sutures, are tied to each other after being passed through drill holes in the posterior greater trochanter. Quadratus femoris, if divided, is repaired separately. A s