Chomiak J, Slavík M, Stĕdrý V
Ortopedická klinika ILF, FNsP Praha, Bulovka.
Acta Chir Orthop Traumatol Cech. 1990 Feb;57(1):40-7.
The authors have made electromyographic examination of m. tensor fasciae latae and m. glutaeus medius and sometimes also minimus in patients after the implantation of total endoprosthesis of the hip joint by anterolateral Watson - Jones approach and transgluteal Bauer approach with the aim to find out if there occurs the anticipated transection of n. glutaeus usp. and dennervation of m. tensor fasciae latae and compare from this viewpoint both approaches. The examination was performed in 18 patients after the implantation of 20 total endoprostheses of the hip joint (out of which 10 hip joints were operated on by Watson - Jones approach and 10 by Bauer approach) in the period of 6-20 weeks after operation. In the examination concentric needle electrodes and NEUROMATIC 2000 C device (produced by DANTEC Co.) were applied. It was found out that the transection of n. glutaeus sup. is inevitable in neither approach. In patients operated on by Watson-Jones approach there occurred only twice complete transection of the nerve with the dennervation of m. tensor fasciae latae, six time incomplete interruption of the nerve and twice the finding in m. tensor fasciae latae was normal. In patients operated on by Bauer approach complete transection of n. glutaeus sup. was found out six times and incomplete interruption of this nerve four times. Thus from this viewpoint Watson-Jones approach is more considerate. Moreover, in Bauer approach eight times there occurred partial interruption of the innervation of the ventral portion of m. glutaeus medius. Consequently, the study has not proved the assumption that both approaches must necessarily result in complete transection of n. glutaeus sup.(ABSTRACT TRUNCATED AT 250 WORDS)
作者对采用前外侧沃森 - 琼斯入路和经臀肌鲍尔入路进行髋关节全关节置换术后的患者,进行了阔筋膜张肌和臀中肌(有时也包括臀小肌)的肌电图检查,目的是确定是否发生了预期的臀上神经横断以及阔筋膜张肌的去神经支配情况,并从这一角度比较两种入路。检查在20例髋关节全关节置换术后的18例患者中进行(其中10例髋关节采用沃森 - 琼斯入路,10例采用鲍尔入路),于术后6至20周进行。检查中应用了同心针电极和NEUROMATIC 2000 C设备(由丹泰克公司生产)。结果发现,两种入路均不可避免地会出现臀上神经横断。在采用沃森 - 琼斯入路的患者中,仅两次出现神经完全横断伴阔筋膜张肌去神经支配,六次出现神经不完全中断,两次阔筋膜张肌检查结果正常。在采用鲍尔入路的患者中,发现臀上神经完全横断六次,不完全中断四次。因此,从这一角度看,沃森 - 琼斯入路更为周全。此外,在鲍尔入路中,臀中肌腹侧部分的神经支配有八次出现部分中断。因此,该研究并未证实两种入路必然会导致臀上神经完全横断的假设。(摘要截断于250字)