文档介绍：髋关节置换
Before performing antegrade femoral nailing, a high-quality
AP radiograph of the hip is necessary to rule out occult
femoral neck fracture.
Many patients with femoral shaft injuries have CT scans performed
to rule out intraabdominal injury. The CT scan cuts through the
femoral neck should also be reviewed to rule out fracture.
Lateral decubitus position is preferred for antegrade femoral
nailing in the patient with normal pulmonary status and no
spine or pelvic injury. The affected leg is flexed, exposing the piriformis fossa without steric interference from the patient’s torso.
The downside leg is well supported and padded to
avoid neuropraxia. The surgeon is pointing to the starting point for the piriformis entry point.
View of the area that is prepped out for
performing the nailing.
PIRIFORMIS
FOSSA
The piriformis fossa entry portal is directly in line with the canal
of the shaft. However, it is slightly posterior to the femoral neck.
It is curvilinear and angled posteriorly.
Because the piriformis entry portal is on a sloped surface, a
straight awl must be introduced first at an angle to the femoral
shaft directly anteriorly…
1
2
…and then as it’s introduced, the hand is raised up to
go in line with the femoral shaft.
1cm
The 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