Lusskin R, Goldman A, Absatz M
Department of Orthopaedic Surgery, New York University Medical Center 10016.
J Arthroplasty. 1988;3(4):313-22. doi: 10.1016/s0883-5403(88)80031-7.
The combined anterior and posterior approach permits access to the front and back of the hip joint for reconstruction and complex arthroplasty, usually without osteotomy of the greater trochanter, with minimal muscle release. There is ease of access to the anterior and posterior capsule, which can be resected under direct vision, thus permitting accurate hemostasis. The entire acetabular rim is exposed for bone grafting as required. The authors review the useful standard approaches and illustrate the combination of the anterior and posterior approaches through a straight lateral incision. Concomitant exploration of the sciatic nerve is demonstrated, as is the osteotomy of the trochanter performed when the ilium superior to the acetabulum must be reconstructed. The utility and limitations of the operation is illustrated by representative cases. This extensive procedure usually can prevent neurologic and vascular compromise and allows excellent observation of the skeletal structures for accurate component alignment.
前后联合入路可用于髋关节的前后侧，以进行重建和复杂的关节置换术，通常无需大转子截骨，肌肉松解程度最小。易于进入前后关节囊，可在直视下切除，从而实现精确止血。根据需要可暴露整个髋臼缘以进行骨移植。作者回顾了有用的标准入路，并通过直外侧切口展示了前后联合入路。演示了同时探查坐骨神经，以及在必须重建髋臼上方的髂骨时进行的转子截骨。通过典型病例说明了该手术的实用性和局限性。这种广泛的手术通常可以防止神经和血管损伤，并能很好地观察骨骼结构，以实现假体组件的精确对齐。
