【摘要】 目的:为髋关节内侧手术入路及如何避免易损伤结构提供解剖学依据。方法:对60侧成尸下肢标本,参照髋关节内侧入路的层次对相关结构和神经血管进行解剖观测。结果:耻骨肌由股神经支配占97.2%,由闭孔神经支配占2.8%;长收肌由闭孔神经前支支配,入肌点与同侧耻骨结节之间的距离为(71.4±23.2)mm(50~95mm);股薄肌由闭孔神经前支支配,入肌点与同侧耻骨结节之间的距离为(138.8±35.1)mm(105~175mm);短收肌和大收肌的前部纤维由闭孔神经后支支配,进入大收肌的神经入肌点与同侧耻骨结节之间距离为(122.2±18.4)mm(102~145mm)。结论:1、髂腰肌与耻骨肌间隙为腰丛分支与股神经的神经界面,耻骨肌与短收肌、大收肌的间隙为股神经和闭孔神经、坐骨神经神经界面。2、手术入路中长收肌是手术的重要标志性结构,从该肌外侧缘深入经缝匠肌与长收肌之间再经髂腰肌与耻骨肌间隙(神经界面)到达病变部位路径;从其内侧缘深入即为从长收肌与股薄肌间隙经短收肌、大收肌与耻骨肌间隙(神经界面)到手术部位路径。更多还原

【Abstract】 Objective:To provide an anatomical basis for both medial approach to hip joint and its surrounding vulnerable structures.Methods:60 adult cadaveric lower extremities were dissected to observe anatomical structures of relative nerves and vascularities according to the operational process.Results:As for pectineus,97.2% of its innervation comes from femoral nerve while the rest 2.8% roots in obturator nerve.The anterior branch of obturator nerve innervates adductor longus, and its origin in the muscle travels approximately a length of 71.4±23.2mm(50～95mm) till it reaches the ipsilateral pubic tubercle.And no significant differences were observed on both sides.Gracilis is controlled by the anterior branch of obturator nerve,and the average distance from its origin in the muscle to the ipsilateral pubic tubercle is 138.8±35.1mm(105～175mm).The anterior muscle fibers belonging to both adductor brevis and magnus are innervated by the posterior branch of obturator nerve,accordingly,it measures 122.2±18.4mm(102～145mm)from the nervous origin in adductor magnus to the ipsilateral pubic tubercle.Conclusion:1.The spatia between sartorius and adductor longus is the interface of femoral nerve and obturator nerve;while the one formed by iliopsoas and pectineus is the interface of the lumbar plexus branches and femoral nerve;also,the interface formed by femoral nerve, obturator nerve and sciatic nerve shapes the spatia among pectineus,adductor brevis and magnus.2.During the operational approach,adductor longus is an important sign.Starting from its lateral boarder,there is a possible path leading to the disease,which passes through two spatium intermusculare:one lies between sartorius and adductor,the other iliopsoas and pectineus.Similarly,there is another path beginning with its medial boarder,and it also consists of two spatium—one is between adductor longus and gracilis,the other is among brevis adductor, magnus adductor and pectineus.[更多还原