髋关节置换资料.pptxVIP

髋关节置换资料第1页/共40页 Before performing antegrade femoral nailing, a high-qualityAP radiograph of the hip is necessary to rule out occultfemoral neck fracture.第2页/共40页 Many patients with femoral shaft injuries have CT scans performedto rule out intraabdominal injury. The CT scan cuts through thefemoral neck should also be reviewed to rule out fracture.第3页/共40页 Lateral decubitus position is preferred for antegrade femoralnailing in the patient with normal pulmonary status and nospine or pelvic injury. The affected leg is flexed, exposing the piriformis fossa without steric interference from the patient’s torso.第4页/共40页 The downside leg is well supported and padded to avoid neuropraxia. The surgeon is pointing to the starting point for the piriformis entry point.第5页/共40页 View of the area that is prepped out for performing the nailing.第6页/共40页 PIRIFORMISFOSSAThe piriformis fossa entry portal is directly in line with the canalof the shaft. However, it is slightly posterior to the femoral neck.It is curvilinear and angled posteriorly.第7页/共40页 Because the piriformis entry portal is on a sloped surface, astraight awl must be introduced first at an angle to the femoralshaft directly anteriorly…12第8页/共40页 …and then as it’s introduced, the hand is raised up togo in line with the femoral shaft.第9页/共40页 1cmThe skin incision, which can be approximately 1 to 1-1/2cm in length, should be made at a distance away from the piriformis fossa to allow for direct entry into the fossa. This can be best estimated by looking第10页/共40页 1cmat the AP radiograph to determine how proximal the incisionneeds to be with respect to the trochanter. The heavier thepatient, the more proximal in the buttocks the incision needs tobe in order to be in line with the femoral shaft.第11页/共40页 The fascia of the Tensor fascia Lata muscle is divided, exposing some of the musculature. 第12页/共40页 The perfect lateral radiograph of the hip demonstrates theneck to be colinear with the shaft and slightly anterior to it