Zhou Xiaoxiao, Ji Houlin, Guo Jinhua, Yang Yang, Cai Pan, Zhang Xianlong
Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai, China.
BMC Musculoskelet Disord. 2020 Feb 24;21(1):119. doi: 10.1186/s12891-020-3088-9.
The osteotomy of the posterolateral overhanging part (PLOP) of the greater trochanter via posterior approach has been used for the hip arthroplasty for decades with good results. However, the osteotomy method remains undefined and the precise adjacent structures around PLOP have not been reported. The purpose of this study was to present a modified PLOP osteotomy approach and perform a detailed study of the topographic and surgical anatomy of the PLOP.
The peri-PLOP soft tissue and the bony parameters were measured using 10 cadavers with 20 hips and 20 skeletal hip specimens, respectively.
A 1.8-cm vertical osteotomy did not jeopardize the femoral neck, and a 1.8-cm wide bone block did not damage the insertions of the short external rotators. The average distances between the most distal branch of the superior gluteal nerve/artery and the 1.8-cm point of the greater trochanter were 5.70 ± 0.66 cm and 6.33 ± 0.56 cm, respectively.
For osteotomy of the PLOP, we suggested that the width of the upper side from the lateral to medial greater trochanter should be 1.8 cm, depth of vertical osteotomy should be 1.8 cm, and length of the posterior edge should be 4 cm. Obturator externus tendon should be kept within the bone block of osteotomy. The proximal extension of the gluteus medius muscle split should be limited to 5.5 cm at the 1.8 cm-point of the greater trochanter.
Prospective comparative study Level II.
经后路对大转子后外侧悬垂部（PLOP）进行截骨术已用于髋关节置换术数十年，效果良好。然而，截骨方法仍不明确，且PLOP周围精确的毗邻结构尚未见报道。本研究的目的是提出一种改良的PLOP截骨方法，并对PLOP的局部解剖和手术解剖进行详细研究。
分别使用10具尸体的20个髋关节和20个骨骼化髋关节标本测量PLOP周围软组织和骨骼参数。
1.8 cm的垂直截骨不会危及股骨颈，1.8 cm宽的骨块不会损伤短外旋肌的附着点。臀上神经/动脉最远端分支与大转子1.8 cm点之间的平均距离分别为5.70±0.66 cm和6.33±0.56 cm。
对于PLOP截骨术，我们建议大转子从外侧到内侧上缘的宽度应为1.8 cm，垂直截骨深度应为1.8 cm，后缘长度应为4 cm。闭孔外肌腱应保留在截骨骨块内。臀中肌劈开的近端延伸在大转子1.8 cm点处应限制在5.5 cm以内。
前瞻性比较研究二级。
