Institute of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria.
Institute of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria; Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
J Arthroplasty. 2024 Apr;39(4):1088-1092. doi: 10.1016/j.arth.2023.10.046. Epub 2023 Oct 31.
Iatrogenic vascular injury during total hip arthroplasty (THA) is rare, reported at rates of 0.05 to 0.3%, but a potentially limb-threatening and life-threatening complication. We aimed to describe safe and danger zones for the superior gluteal vessel bundle (SGV bundle) with reference to different THA approaches.
There were 27 formalin-fixed cadavers with 49 hemipelves dissected. The course and distribution of the SGV bundle were investigated with the help of anatomical landmarks like the greater trochanter, the iliac tubercle (IT), and the ischial tuberosity.
We found and exposed the SGV bundle in all 49 specimens with no sex-specific differences. No SGV bundle was encountered up to 28 mm from the greater trochanter and up to 16 mm below the IT. The zone with the highest probability of finding the vessels was 25 to 65 mm below the IT in 39 (80%) cases - defining a danger zone (in relation to the skin incision) in the proximal fourth for the direct anterior approach, in the proximal half for the antero-lateral approach, in the proximal fifth for the direct lateral approach, and almost no danger zone for the posterior approach.
Special care in proximal instrument placement should be taken during THA. When extending one of the surgical approaches, manipulations in the proximal, cranial surgical window should be performed with the utmost care to avoid SGV bundle injury.
全髋关节置换术（THA）过程中医源性血管损伤较为罕见，发生率为 0.05%至 0.3%，但却是一种潜在的危及肢体和生命的并发症。我们旨在描述不同 THA 入路时，臀上血管束（SGV 束）的安全和危险区域。
对 27 具福尔马林固定的尸体进行了 49 半骨盆解剖。借助大转子、髂结节（IT）和坐骨结节等解剖学标志，研究了 SGV 束的走行和分布。
我们在所有 49 个标本中都发现并暴露了 SGV 束，且没有性别差异。在距大转子 28mm 以内和 IT 以下 16mm 以内均未发现 SGV 束。在 39 例（80%）病例中，最有可能发现血管的区域为 IT 以下 25-65mm，定义了一个危险区域（相对于皮肤切口）：对于直接前入路，在近端四分之一；对于前外侧入路，在近端一半；对于直接外侧入路，在近端五分之一；而对于后入路，几乎没有危险区域。
THA 时应特别注意近端器械的放置。当延长其中一种手术入路时，应非常小心地在近端、颅侧手术窗中进行操作，以避免 SGV 束损伤。
