范先东,吕明
FAN Xiandong,LV Ming

• 1:中国人民解放军第251医院
• 2:北京积水潭医院

摘要(Abstract)：

目的:研究髋关节后外侧入路中不同软组织结构松解顺序对髋关节伸直位时张力的影响。方法:选择5具新鲜冰冻人体尸体(10例髋关节),采用2种方法通过髋关节后外侧入路,对软组织进行松解;(1)先松解关节囊,然后松解阔筋膜和髂胫束,再松解臀大肌止点,髂腰肌止点;(2)先松解阔筋膜和髂胫束,然后松解关节囊,再松解臀大肌止点,髂腰肌止点;在骨盆髂前上棘位置垂直于床面固定一根克氏针,在股骨干侧方固定另一根克氏针,测量软组织松解操作前后两根克氏针之间的位移变化。结果:采用第1种松解方法,在进行单纯牵引、外旋肌切断、后关节囊切开和臀大肌止点切断操作后,两克氏针距离与操作前比较无明显位移变化(P<0.05),在股骨头切除、关节囊全部切除、阔筋膜髂胫束切断、髂腰肌腱切断后,两克氏针距离有明显变化,差异有统计学意义(P<0.05);采用第2种松解方法,在进行单纯牵引、外旋肌切断、后关节囊切开和臀大肌止点切断操作后,两克氏针距离与操作前比较无明显位移变化(P<0.05),在进行股骨头切除、关节囊全部切除、阔筋膜髂胫束切断、髂腰肌腱切断操作后,两克氏针距离差异有统计学意义(P<0.05)。结论:关节囊、阔筋膜髂胫束松解可以降低髋关节伸直位的软组织张力,其中前关节囊和阔筋膜髂胫束的作用最大;髋关节周围的软组织对张力的影响相互制约,单一松解其中一种结构不能获得满意的松解效果。
Objective: To investigate the effect of the sequence of different soft tissue release by posterolateral approach on hip joint tension. Methods: Five fresh frozen cadavers( 10 hip joint cases)were selected. Posterolateral approach was adopted for two sequences of soft tissue release. The first approach was that joint capsule was released first,fascia lata and iliotibial band were then released,and finally gluteus maximus and iliopsoas muscle were released. The second approach was that fascia lata and iliotibial band were released first,and then joint capsule was released,and finally gluteus maximus and iliopsoas muscle were released. One Kirschner wire was fixed at the bone near the anterior superior iliac spine,and the wire was perpendicular to the operating table. Another Kirschner wire was fixed into the bone at lateral femoral shaft. The distance between the two Kirschner wires was measured before and after each soft tissue structure release. The measured data were statistically analyzed. Results: The results by approach 1 showed that there were no significant displacement changes before and after pure traction,extortor cutting off,posterior joint capsule cutting open,gluteus maximus severing in the same sample by a same operation( P < 0. 05). The difference of the distance between the two Kirschner wires before and after femoral head excision,total excision of joint capsule,fascia lata and iliotibial band severing,and iliopsoas tendon severing was statistically significant( P <0. 05). The results by approach 2 showed that the difference of displacement changes before and after pure traction,extortor cutting off,posterior joint capsule cutting open,gluteus maximus severing in the same sample was not statistically significant( P > 0. 05). The difference of the distance between the two Kirschner wires before and after femoral head excision,total excision of joint capsule,fascia lata and iliotibial band severing,and iliopsoas tendon severing was statistically significant( P < 0. 05).Conclusions: The release of joint capsule,fascia lata and iliotibial band can decrease the straight soft tissue tension around hip joint,among which the anterior capsule and tensor fasciae latae( iliotibial band) make the most effective result. To maintain the soft tissue tension around hip joint depends on different structures working together,releasing one structure alone may not obtain the optimal result.

关键词(KeyWords)： 髋关节;后外侧入路;软组织;软组织张力;松解顺序
hip joint;posterolateral approach;soft tissue;soft tissue tension;release sequence

Abstract:

Keywords:

基金项目(Foundation): 河北省张家口市指导性课题(编号:1021126D)

作者(Author): 范先东,吕明
FAN Xiandong,LV Ming

DOI: 10.19367/j.cnki.1000-2707.2015.10.032

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