目的通过髋部的影像学和解剖学研究，为PipkinⅠ、Ⅱ型股骨头骨折提供一种新的手术入路。
方法收集2023年6月至2024年1月期间上海交通大学医学院附属第六人民医院因胫腓骨开放性骨折而行下肢CT血管成像检查的38例患者髋部影像学数据。男20例，年龄为（40.9±3.5）岁；女18例，年龄为（41.5±3.3）岁。观察股动脉及其主要分支的起源及走形特点，并测量股动脉、旋股内侧动脉、旋股外侧动脉与股骨头之间的最短距离。取新鲜成年尸体标本4具，男2具，女2具；死亡年龄分别为56、65、72、78岁。从腹股沟韧带中点沿肢体轴线切开皮肤、皮下，经股动脉和股神经之间的间隙显露股骨头，标记股骨头显露范围。
结果股动脉走行在股骨头前内侧，旋股内侧动脉与股骨头的最短距离为（13.1±5.7）mm，旋股外侧动脉起点与股骨头的最短距离为（21.6±8.6）mm，在CT血管成像侧位上大转子顶点平面股动脉距离股骨头（20.6±4.9）mm。大体标本显示股动脉与股神经之间只有血管细小分支，分别将股动脉和股神经拉向内、外侧，牵开肌肉并打开髋关节囊可以直接显露股骨头前下方。牵引后，内、外旋髋关节可进一步扩大股骨头的显露范围。将股动脉与股神经之间的解剖间隙入路命名为髋关节前内侧入路（AMA）。
结论AMA利用股动脉和股神经之间的解剖间隙，为PipkinⅠ、Ⅱ型股骨头骨折的显露与固定提供了一种新的手术入路选择。
ObjectiveTo explore a new surgical approach [anteromedial approach of the hip (AMA)] for Pipkin Ⅰ and Ⅱ femoral head fractures through an imaging and anatomical study.
MethodsThe hip imaging data were collected of the 38 patients who had undergone lower limb CT angiography for open tibiofibular fractures at Department of Orthopaedics, The Sixth People’s Hospital, School of Medicine, Shanghai Jiao Tong University from June 2023 to January 2024. There were 20 males aged (40.9±3.5) years and 18 females aged (41.5±3.3) years. The origins and shapes of the femoral artery and its main branches were observed. The distances between the femoral head and the femoral artery, the medial femoral circumflex artery, and the lateral femoral circumflex artery were measured. Four fresh adult cadavers were collected, including 2 males and 2 females. Their ages of death were 56, 65, 72 and 78 years old, respectively. An incision was made along the axis of the limb at the midpoint of the inguinal ligament at the 4 fresh cadavers. After the femoral head was exposed through the gap between the femoral artery and the femoral nerve, the range of the femoral head exposed was marked.
ResultsThe femoral artery ran along the anteromedial side of the femoral head. The shortest distance between the medial femoral circumflex artery and the femoral head was (13.1±5.7) mm, and the shortest distance between the origin of the lateral femoral circumflex artery and the femoral head (21.6±8.6) mm. On the lateral view of CT angiography, the distance between the femoral artery and the femoral head was (20.6±4.9) mm at the level of the apex of greater trochanter. Gross observation on the cadavers found only small branches of vessels between the femoral artery and the femoral nerve. After the femoral artery and femoral nerve were respectively pulled medially and laterally, the anterior-inferior part of the femoral head was exposed directly by pulling the muscles to open the joint capsule. The exposure range of the femoral head was further expanded through internal and external rotation of the hip joint under traction. The anatomical gap between the femoral artery and the femoral nerve was named the AMA.
ConclusionAMA utilizes the potential gap between the femoral artery and the femoral nerve, providing a new surgical approach for exposure and fixation of Pipkin type Ⅰ and Ⅱ femoral head fractures.
关俊杰,刘辰骏,范致远,等. 髋关节前内侧入路治疗PipkinⅠ、Ⅱ型股骨头骨折的影像学和解剖学研究[J]. 中华创伤骨科杂志,2025,27(03)：210-215.
DOI:10.3760/cma.j.cn115530-20241225-00505版权归中华医学会所有。
未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。
除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。
关俊杰、刘辰骏、范致远、齐鑫、徐宁：大体标本操作、影像学分析、论文撰写；杨伟超、孙辉、宋飒：数据整理、统计学分析；张伟：研究指导、论文修改、经费支持
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