Stecco Carla, Macchi Veronica, Baggio Luca, Porzionato Andrea, Berizzi A, Aldegheri Roberto, De Caro Raffaele
Section of Anatomy, Department of Molecular Medicine, University of Padova, Padua, Italy.
Surg Radiol Anat. 2013 Mar;35(2):107-13. doi: 10.1007/s00276-012-1014-z. Epub 2012 Sep 16.
To identify the site of incision with the lowest risk of injury of the superior gluteal neurovascular pedicle in the total hip arthroplasty with Hardinge's direct lateral approach.
Eight fresh donated bodies were dissected and the branches of the superior gluteal nerve (SGN) and superior gluteal artery (SGA) were dissected. The distance between the SGA and the apex of greater trochanter (GT) was also evaluated in vivo in 29 patients by CT angiography.
We observed 12 spray pattern and 4 transverse neural trunk pattern of the SGN. In all cases the nerve runs inferiorly to the artery, with a mean distance of 0.5 cm. At the CT angiography the average distance between the main branch of SGA and the GT was 5.2 cm, indicating a mean distance of 4.7 cm from the SGN to the GT. Terminal branches of SGA are found until 2.7 cm from GT.
This study analyzed the relationships between superior gluteal neurovascular pedicle and the GT in vivo (considering also the muscular tone), showing that during direct lateral access a safe area of 4.7 cm exists from the GT to the SGN and of 3.5 cm to its lower rami.
确定在采用哈丁格直接外侧入路的全髋关节置换术中，臀上神经血管蒂损伤风险最低的切口部位。
解剖8具新鲜捐赠尸体，解剖臀上神经（SGN）和臀上动脉（SGA）的分支。还通过CT血管造影在29例患者体内评估了SGA与大转子（GT）顶点之间的距离。
我们观察到SGN有12种分支呈喷雾状和4种呈横向神经干状。在所有病例中，神经走行于动脉下方，平均距离为0.5厘米。在CT血管造影中，SGA主要分支与GT之间的平均距离为5.2厘米，表明从SGN到GT的平均距离为4.7厘米。在距GT 2.7厘米处可发现SGA的终末分支。
本研究分析了臀上神经血管蒂与GT在体内的关系（同时考虑肌肉张力），表明在直接外侧入路时，从GT到SGN存在4.7厘米的安全区，到其下支存在3.5厘米的安全区。
