股骨大转子后方肌腱止点的解剖学观测及临床意义

目的:探讨股骨大转子后方肌腱止点的解剖学特征,为临床实践提供解剖学资料。方法:对10例20侧福尔马林固定成人髋关节标本进行解剖,观察各肌腱的末段形态,测量其宽、厚度及肌外腱长;逐步清除各肌腱组织,观察各肌腱止点在股骨大转子上的分布。结果:梨状肌腱和闭孔内肌上、下孖肌总腱的末段形成联合腱,闭孔外肌腱独立附着,臀中肌腱附着区后部增厚强韧;梨状肌压迹、闭孔内肌压迹和转子窝形态各异,在大转子上分布不同,股骨中轴线通过转子窝。结论:在全髋置换后路软组织扩大修补中,联合腱应联合附着,闭孔外肌腱应独立附着,联合腱缝入臀中肌腱后缘在解剖上是合理的;在股骨顺行髓内钉的手术操作中,转子窝应是正确的进针点。

Anatomic study and clinical significance of tendon insertions posterior to the femoral greater trochanter

Objective:To investigate the anatomic features of tendon insertions posterior to the femoral greater trochanter for clinical practice.Methods: Twenty adult cadaver hips fixed with formalin were used for anatomic study.Following the extremities of every tendon being observed,its width,thickness and tendon length outside muscle were measured.After the tendon tissues were removed gradually,the distribution of tendon insertions in the femoral greater trochanter was observed.Results: The extremities of the piriformis,gemellus superior,obturator internus and gemellus inferior formed conjoined tendon.Obturator externus tendon cohered independently.The posterior part of gluteus medius attachment region became thick and tough.Piriformis impression,obturator internus impression and trochanteric fossa had different appearances and different distributions in the femoral greater trochanter.Femoral central axis was past through the trochanteric fossa.Conclusion: Understanding the tendon insertions in the femoral greater trochanter may be helpful to the operative manipulation of enhanced posterior soft tissue repairs in total hip arthroplasty and antegrade femoral nailing.