REDEFINITION OF MINIMAL INVASIVE SURGICAL INCISIONS USED IN ARTHROPLASTIC HIP SURGERY

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全文:

Minimally invasive approaches to the hip show promise for less muscle trauma compared to conventional approaches. However, the surgical incisions used for such approaches are not well defined. Since the surgical window of minimal invasive surgeries are narrow, the risk of damaging the neurovascular structures around the hip is more likely when compared to alternative approaches. Aim. The aim of this presentation is to review the anatomic course of the nerves around the hip region and to define alternative surgical incisions under guidance of standard anatomical landmarks during minimally invasive approaches to the hip to prevent iatrogenic injuries. Materials and Methods. The courses of the superior gluteal nerve (SGN) and inferior gluteal nerve (IGN) and their branches documented on 28 gluteal regions of 14 formalin-fixed cadavers. Results and Discussion. The surgical incisions were suggested by taking the posterior inferior iliac spine, greater trochanter and a line connecting these two points as reference. Based on the results of this review, the safe zone for the SGN and IGN can be suggested to be smaller than previously reported. Use of a minimally invasive direct posterior or lateral approach to this region puts the branches to the gluteus medius at risk. Moreover, a minimally invasive anterolateral approach to the hip may compromise branches to the tensor fasciae latae muscle. Conclusions. Using the surgical incisions defined in this review may decrease surgical morbidity during minimal invasive arthroplastic hip surgery.