Georgiadis G M, Olexa T A, Ebraheim N A
Department of Orthopaedic Surgery, Medical College of Ohio, Toledo 43699-0008, USA.
Clin Orthop Relat Res. 1996 Sep(330):281-7. doi: 10.1097/00003086-199609000-00036.
Dissections on 42 anatomic specimen hips were performed to study proximal femoral anatomy as it pertains to entry sites for intramedullary nailing. The precise relationships of muscle insertions on the greater trochanter were documented, as were the boundaries of the digital fossa. Measurements of trochanteric bony anatomy were made on a separate group of 30 dry bone unpaired proximal femora. Finally, possible clinical insertion sites were studied radiographically by placing a series of guidewires at various locations in the proximal femur. Two areas tended to align well with the longitudinal axis of the proximal intramedullary canal: the digital fossa, which is the site of the insertion of the obturator externus; and the posterior aspect of the superior border of the trochanter. This second area is the tip of the trochanter posterior to the piriformis fossa. This study suggests that either location may be suitable for an insertion point for intramedullary nailing. Precise sagittal plane localization of the entry site, which can be made on lateral views with an image intensifier, is recommended.
对42个解剖学标本髋关节进行了解剖，以研究与髓内钉入点相关的股骨近端解剖结构。记录了大转子上肌肉附着点的精确关系以及数字窝的边界。在另一组30个未配对的干燥股骨近端上对转子骨解剖结构进行了测量。最后，通过在股骨近端的不同位置放置一系列导丝，对可能的临床入点进行了影像学研究。有两个区域倾向于与近端髓内管的纵轴良好对齐：数字窝，即闭孔外肌的附着点；以及转子上缘的后侧。第二个区域是梨状肌窝后方的转子尖端。本研究表明，这两个位置都可能适合作为髓内钉的入点。建议使用影像增强器在侧位片上对入点进行精确的矢状面定位。
