Franken Veerle, Blümel Stefan, Schwab Joseph M, Tannast Moritz
Department of Orthopedic Surgery and Traumatology, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland.
Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Arch Orthop Trauma Surg. 2024 Dec 18;145(1):67. doi: 10.1007/s00402-024-05622-w.
The Gibson approach, used in hip-preserving surgery, is intermuscular and develops the space anteriorly to the gluteus maximus. Reliable anatomical landmarks for the development of this interval do not exist, but the interval is marked by perforating vessels (PV) of the inferior gluteal artery. The aim of this study was to provide reference values for the relationship between palpable anatomical landmarks on the femur/pelvis and the anterior border of the gluteus maximus using CT scans of the proximal femur.
Single center retrospective study of 617 hips who underwent a CT-scan of the pelvis/femur. We defined 5 anatomical markers on the pelvis and proximal femur and measured the distance of the anterior border of the gluteus maximus in relation to the marker, which was either anterior or posterior. The amount PV's and it's location relative to the innominate tubercle were measured in the coronal plane. For each landmark we compared these subgroups: male vs female, age < 40 vs ≥ 40, categorical age (< 20; 20-40; 40-60; > 60), and categorical femoral torsion (< 10°; 10°-25°; 25°-35°; > 35°).
Mean location of the parameters A-E was at - 8.1 cm, 1.1 cm, 1.8 cm, 1.3 cm and 0.4 cm. Parameters B, C, and D were more posterior in the age ≥ 40 group. Parameters A-E were significantly more posterior in the age > 60 group. Parameters A and E were significantly more anterior in females than in males. 50% of the PV are found between 5 and 9 cm proximal to the innominate tubercle. No statistically significant differences were noted in the location of any of the perforating vessels in the different subgroups.
The Gibson interval is located more anteriorly in female patients and patients under 40 years of age. It is located more posteriorly in patients over 60 years of age. In addition, the interval moves anteriorly with increasing femoral torsion, most notably in patients with very high femoral torsion (> 35°).
吉布森入路用于保髋手术，是一种肌间隙入路，在臀大肌前方开辟间隙。目前尚无确定该间隙的可靠解剖标志，但臀下动脉穿支血管（PV）可作为该间隙的标志。本研究旨在通过股骨近端CT扫描，提供股骨/骨盆上可触及的解剖标志与臀大肌前缘之间关系的参考值。
对617例接受骨盆/股骨CT扫描的髋关节进行单中心回顾性研究。我们在骨盆和股骨近端定义了5个解剖标志，并测量臀大肌前缘相对于这些标志的距离，该距离有前位或后位之分。在冠状面测量穿支血管的数量及其相对于无名结节的位置。对于每个标志，我们比较了以下亚组：男性与女性、年龄<40岁与≥40岁、分类年龄（<20岁；20 - 40岁；40 - 60岁；>60岁）以及分类股骨扭转（<10°；10° - 25°；25° - 35°；>35°）。
参数A - E的平均位置分别为 - 8.1 cm、1.1 cm、1.8 cm、1.3 cm和0.4 cm。在年龄≥40岁组中，参数B、C和D更靠后。在年龄>60岁组中，参数A - E显著更靠后。参数A和E在女性中比在男性中显著更靠前。50%的穿支血管位于无名结节近端5至9 cm之间。不同亚组中任何穿支血管的位置均未观察到统计学显著差异。
吉布森间隙在女性患者和40岁以下患者中位置更靠前。在60岁以上患者中位置更靠后。此外，随着股骨扭转增加，该间隙向前移动，在股骨扭转非常高（>35°）的患者中最为明显。
