髋关节前外侧入路_Watson_Jones切口

1、1、术前准备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.前外侧入路即W-J入路显露股骨近端，通过臀肌与阔筋膜张肌之间有限显露髋 关节及股骨近端。在牵开器帮助和充分的软组织松解的情况下，可以用来复位 股骨颈骨折(31-b)，有时也可以复位些股骨头骨折(31-C )。一个更靠内侧显露髋关节的切口如 Iliofemoral切口或S-P切口，在阔筋膜张肌内侧，可 以提供显露股骨头和股骨颈，但是如果用DHS固定股骨颈骨折，则需要一个独立的外侧切口。2、皮肤切口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.在股骨大转子上约7-10cm外侧

5、略前方处行轻微弯曲皮肤切口（方向从髂结节3、显露阔筋膜张肌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.锐性显露阔筋膜张肌。在股骨处切开阔筋膜张肌并向近端沿着阔筋膜张肌后侧边界锐性分离。4、深层分离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.显露大粗隆及臀中肌，将阔筋膜张肌向前方牵开，臀中肌向后方牵开。钝性分离臀中肌与阔筋膜张肌之间间隙向近端延伸至髋关节。注意此间隙的血管术，可以结扎或电凝止血。Anterolateral approach5、显露髋关节囊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.在髋关节股骨头部放置Hohmann拉钩，另外在前和后方各放置一个拉钩，可 以显露解剖间隙。外旋大腿将有助于显露髋关节囊Anterolateral approachSuperior gluteal nerve Superior gluteal vessels Rectus ferrorisIliopsoasGluteus minimusGluteus mediijsPSVastus lateral isTrocha ntei匚 bursaPirifornnis-ilio

9、psoasGluteus medium6松解股外侧肌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.从大转子前

10、下方剥离股外侧肌起点显露潜在的关节囊，向下牵拉肌肉视需要调整拉钩，清除关节周围的脂肪Anterolateral approachSuperior gluteal nerve Superior gluteaf Rectus fem orisvesselsHiofemoral ligamentGluteus minimsVastus lateralisTrochanteric bursa7、打开关节囊Make an T- shaped incision in the capsule,关节囊做一个T型切口AnteroMteral approachSuperior glutealRectum femo

11、ris IliopsoasGluteus minimusVastus laterdlisdiofemoral ligamentGluteus mediu?Trochanteric bursa8、打开关节囊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.在关节囊前方和后方置入两根缝合线，以保护髋臼。此关节囊切开术可以显露股骨头和颈前面，外侧牵开或旋转大腿可以增加显露。此切口可以沿股外侧肌延长，以便拧入股骨颈螺钉或DHS来固定股骨颈骨折Superior glutea In erve Superi

13、orRectus femorisGluteus minimusGluteus mediumGluteus medju5HTrochanteric bursa9、闭合伤口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.闭合伤口前仔细清除所有软组织。清除坏死组织并冲洗整个伤口以减少