Checroun A J, Mekhail A O, Ebraheim N A, Jackson W T, Yeasting R A
Department of Orthopaedic Surgery, Medical College of Ohio, Toledo 43699-0008, USA.
J Orthop Trauma. 1996;10(7):481-6. doi: 10.1097/00005131-199610000-00006.
A proposed extensile medial approach to the medial surface of the shaft of the femur was studied on 30 cadaver thighs. The incision is made along a line extending from the mid inguinal point to a point one-third the distance from the adductor tubercle to the medial side of the patella. After mobilizing the sartorius muscle posteromedially, the medial femur is exposed by a three-step technique. Step I involves bluntly defining the internervous plane distally between the vastus medialis muscle and the adductor magnus tendon until limited proximally by the distal end of the vastoadductor membrane at an average of 9 cm from the adductor tubercle. In step II blunt dissection between the vastus medialis and the adductor longus muscles is carried from proximal to distal until limited by the proximal end of the vastoadductor membrane. Now the well-defined vastoadductor membrane area ("danger zone") measuring 6 cm in length on average is safely dealt with (step III) and the medial femur is exposed. Distal extension can be made to expose the knee joint. The approach can be extended proximally to the lesser trochanter between the vastus medialis and both the adductor brevis and pectineus muscles. Anatomic measurements in relation to the adductor tubercle and cross-sections of the thigh were made to better describe anatomic constants and variables in this rather unfamiliar medial thigh area.
在30具尸体大腿上研究了一种提议的用于股骨骨干内侧面的扩大内侧入路。切口沿一条从腹股沟中点延伸至从内收肌结节到髌骨内侧缘距离的三分之一处的线进行。将缝匠肌向后方内侧游离后，通过三步技术暴露股骨内侧。第一步，在股内侧肌和大收肌腱之间钝性分离远端的神经间平面，直至近端受大收肌膜远端限制，平均距内收肌结节9厘米。第二步，在股内侧肌和长收肌之间从近端向远端进行钝性解剖，直至受大收肌膜近端限制。现在，平均长度为6厘米的界限清楚的大收肌膜区域（“危险区”）得到安全处理（第三步），股骨内侧得以暴露。可向远端延伸以暴露膝关节。该入路可向近端延伸至股内侧肌与短收肌和耻骨肌之间的小转子处。进行了与内收肌结节相关的解剖测量以及大腿横断面测量，以更好地描述这个相对不熟悉的大腿内侧区域的解剖常数和变量。
