Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, the Netherlands.
Acta Orthop. 2010 Dec;81(6):696-702. doi: 10.3109/17453674.2010.537804.
Minimally invasive surgery (MIS) for hip replacement is thought to minimize soft tissue damage. We determined the damage caused by 4 different MIS approaches as compared to a conventional lateral transgluteal approach.
5 surgeons each performed a total hip arthroplasty on 5 fresh frozen cadaver hips, using either a MIS anterior, MIS anterolateral, MIS 2-incision, MIS posterior, or lateral transgluteal approach. Postoperatively, the hips were dissected and muscle damage color-stained. We measured proportional muscle damage relative to the midsubstance cross-sectional surface area (MCSA) using computerized color detection. The integrity of external rotator muscles, nerves, and ligaments was assessed by direct observation.
None of the other MIS approaches resulted in less gluteus medius muscle damage than the lateral transgluteal approach. However, the MIS anterior approach completely preserved the gluteus medius muscle in 4 cases while partial damage occurred in 1 case. Furthermore, the superior gluteal nerve was transected in 4 cases after a MIS anterolateral approach and in 1 after the lateral transgluteal approach. The lateral femoral cutaneous nerve was transected once after both the MIS anterior approach and the MIS 2-incision approach.
The MIS anterior approach may preserve the gluteus medius muscle during total hip arthroplasty, but with a risk of damaging the lateral femoral cutaneous nerve.
微创髋关节置换术（MIS）被认为可最大限度地减少软组织损伤。我们比较了 4 种不同的 MIS 入路与传统外侧经臀肌入路，以确定它们造成的损伤。
5 位外科医生分别使用 MIS 前路、MIS 前外侧入路、MIS 双切口、MIS 后入路或外侧经臀肌入路对 5 个新鲜冷冻尸体髋关节进行全髋关节置换术。术后，髋关节被解剖并进行肌肉损伤染色。我们使用计算机颜色检测，测量相对于中质横截面面积（MCSA）的肌肉损伤比例。通过直接观察评估外旋肌、神经和韧带的完整性。
与外侧经臀肌入路相比，其他 MIS 入路都没有导致臀中肌损伤更少。然而，MIS 前路入路在 4 例中完全保留了臀中肌，而在 1 例中发生了部分损伤。此外，在 MIS 前外侧入路后，有 4 例发生了臀上神经切断，在外侧经臀肌入路后有 1 例发生了臀上神经切断。在 MIS 前路入路和 MIS 双切口入路后，各有 1 例发生了外侧股皮神经切断。
MIS 前路入路在全髋关节置换术中可能保留臀中肌，但有损伤外侧股皮神经的风险。
