改良Hardinge小切口应用于髋关节置换术的解剖学及临床分析-外科学专业论文.docx

PAGE PAGE 10 的平均比值分别为 S1：0.5298±0.0215，S2：0.4746±0.0250，S3：0.5042±0.0250 （ x ±s ）， 而 这 个 相 对 距 离 在 人 群 中 的 99% 医 学 参 考 值 范 围 依 次 为 （0.47,0.59），（0.41,0.54），（0.44,0.57）。依据此参考值范围的最小值，确定 每一位患者 MIB 的体表投影和手术操作的安全区域。在 3 具尸体双侧臀部（共 计 6 侧）上模拟的改良入路手术中，解剖均未发现 MIB 及其它明显神经血管 损伤。2.改良 Hardinge 小切口组患者在术中、术后等早期疗效指标上明显优 于原始 Hardinge 切口组（P0.05）。且改良组在整个手术过程中的手术视野充 足，不会影响关节的暴露和假体的植入。 结论：依据本研究 99%医学参考值范围最小值所确定的 MIB 在体表的弧 形投影线与股骨大转子外侧最凸点构成了一个手术安全区域，在这个区域内 解剖没有发现明显的神经和血管分布，经过本研究改良后的 Hardinge 入路在 手术操作过程中均未超出此安全区域，不会损伤到 MIB 及其它重要神经血管， 并具有创伤较小、康复较快等诸多优点，是一种安全有效的手术方式。 关键词：臀上神经；髋关节置换；改良 Hardinge 入路 THE ANTOMY AND CLINICAL RESEARCH OF MINIMAL INCICION HIP ARTHROPLASTY THROUGH MODIFIED HARDINGE APPROACH ABSTRACT Objective: To determine the surface projection of the most inferior branch (MIB) of the superior gluteal nerve(SGN) and a secure region avoiding the MIB, to provide the anatomic support for minimal incision hip arthroplasty through modified Hardinge approach and explore the advantages by clinical applications. Methods: 1.Dissect and position the MIB of the SGN and other important nerves and vasculars on 100 hips of 50 cadavers. Measure the relative distances from the MIB to the surrounding skeletal anatomic landmarks and calculate their 99% medical reference ranges in the crowd by which we can determine the surface projection of the MIB and the secure region. Simulated operations of minimal incision hip arthroplasty through modified Hardinge approach was implemented in the region on 6 hips of 3 cadavers to verify the security by analyzing the injury of nerves and vasculars in the region after operations.2.The anatomic result of this study was applied to clinical operations. 26 cases of hip arthroplast were performed through modified Hardinge approach and 26 patients were performed hip arthroplast through traditional Hardinge approach. Data of operation and postoperation has been analysed and compared. Results: 1. the average ratios of relative distances from the surface pro