University of Glasgow, Laboratory of Human Anatomy, University of Glasgow, Glasgow, G12 8QQ, UK.
Golden Jubilee National Hospital, Department of Orthopaedics, Agamemnon Street, Clydebank, G81 4DY, UK.
Bone Joint Res. 2014 Jun;3(6):212-6. doi: 10.1302/2046-3758.36.2000255.
Acetabular retractors have been implicated in damage to the femoral and obturator nerves during total hip replacement. The aim of this study was to determine the anatomical relationship between retractor placement and these nerves.
A posterior approach to the hip was carried out in six fresh cadaveric half pelves. Large Hohmann acetabular retractors were placed anteriorly, over the acetabular lip, and inferiorly, and their relationship to the femoral and obturator nerves was examined.
If contact with bone was not maintained during retractor placement, the tip of the anterior retractor had the potential to compress the femoral nerve by passing superficial to the iliopsoas. If pressure was removed from the anterior retractor, the tip pivoted on the anterior acetabular lip, and passed superficial to the iliopsoas, overlying and compressing the femoral nerve, when pressure was reapplied. The inferior retractor pierced the obturator membrane in all specimens medial to the obturator nerve, with subsequent retraction causing the tip to move laterally, making contact with the nerve.
Iliopsoas can only offer protection to the femoral nerve if the retractor passes deep to the muscle bulk. The anterior retractor should be reinserted if pressure is removed intra-operatively. Vigorous movement of the inferior retractor should be avoided. Cite this article: Bone Joint Res 2014;3:212-6.
髋关节置换术中，髋臼牵开器会损伤股神经和闭孔神经。本研究旨在明确牵开器位置与这些神经的解剖关系。
对 6 具新鲜髋关节半骨盆标本行后路入路。将大型 Hohmann 髋臼牵开器置于髋臼前缘，越过髋臼缘，置于下方，并检查其与股神经和闭孔神经的关系。
如果在牵开器放置过程中不保持与骨接触，前牵开器的尖端可能会因位于腰大肌浅面而压迫股神经。如果从前牵开器上移除压力，尖端会在前髋臼缘上枢轴转动，位于腰大肌浅面，覆盖并压迫股神经，再次施加压力时。下牵开器在所有标本中均穿过闭孔膜进入闭孔神经内侧，随后的牵开导致尖端向外侧移动，与神经接触。
只有当牵开器穿过肌肉深部时，腰大肌才能为股神经提供保护。如果术中移除压力，应重新插入前牵开器。应避免下牵开器剧烈运动。
Bone Joint Res 2014;3:212-6.
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