Shubert Daniel, Madoff Samuel, Milillo Ralph, Nandi Sumon
Tufts University School of Medicine, Boston, Massachusetts.
New England Baptist Hospital, Boston, Massachusetts.
J Arthroplasty. 2015 Jan;30(1):145-8. doi: 10.1016/j.arth.2014.08.024. Epub 2014 Sep 6.
Neurovascular injury during total hip arthroplasty (THA) may result in considerable morbidity or mortality. The most common cause of intraoperative neurovascular injury during THA is retractor compression. Our aims were to: 1) determine proximity of common acetabular retractor positions during THA to adjacent neurovascular structures; and 2) determine effect of patient gender on these measurements. Retractor to neurovascular structure distances were measured on 32 preoperative computed tomography images and 16 cadavers. Our data suggest the anterior inferior iliac spine is the safest anterior acetabular retractor position. With inferior progression along the anterior wall, the distance to the femoral neurovascular bundle decreases. Due to its proximity to the sciatic nerve, the position of the posterior retractor should be monitored during acetabular preparation, particularly in women.
全髋关节置换术（THA）期间的神经血管损伤可能导致相当高的发病率或死亡率。THA术中神经血管损伤的最常见原因是牵开器压迫。我们的目的是：1）确定THA期间常见髋臼牵开器位置与相邻神经血管结构的接近程度；2）确定患者性别对这些测量结果的影响。在32张术前计算机断层扫描图像和16具尸体上测量了牵开器与神经血管结构的距离。我们的数据表明，髂前下棘是髋臼前侧牵开器最安全的位置。沿着前壁向下移动时，与股神经血管束的距离会减小。由于后牵开器靠近坐骨神经，在髋臼准备过程中应监测其位置，尤其是在女性患者中。
