The Antomy And Clinical Research Of Minimal Incicion Hip Arthroplasty Through Modified Hardinge Approach

Objective: To determine the surface projection of the most inferior branch (MIB) of the superior gluteal nerve(SGN) and a secure region avoiding the MIB, to provide the anatomic support for minimal incision hip arthroplasty through modified Hardinge approach and explore the advantages by clinical applications.Methods: 1.Dissect and position the MIB of the SGN and other important nerves and vasculars on 100 hips of 50 cadavers. Measure the relative distances from the MIB to the surrounding skeletal anatomic landmarks and calculate their 99% medical reference ranges in the crowd by which we can determine the surface projection of the MIB and the secure region. Simulated operations of minimal incision hip arthroplasty through modified Hardinge approach was implemented in the region on 6 hips of 3 cadavers to verify the security by analyzing the injury of nerves and vasculars in the region after operations.2.The anatomic result of this study was applied to clinical operations. 26 cases of hip arthroplast were performed through modified Hardinge approach and 26 patients were performed hip arthroplast through traditional Hardinge approach. Data of operation and postoperation has been analysed and compared.Results: 1. the average ratios of relative distances from the surface projection of the MIB to the surrounding skeletal anatomic landmarks were respectively S1:0.5298±0.0215,S2:0.4746±0.02450,S3:0.5042±0.0250( x±s),their 99% medical reference ranges in the crowd were respectively(0.47,0.59),(0.41,0.54),(0.44,0.57). We can determined the surface projection of the MIB and the secure region by minimum of the reference range in every case. We did not find any injury of nerves and vasculars in simulated operations of modified Hardinge approach on 6 hips of 3 cadavers. 2. Data of operation and postoperation through modified Hardinge approach were significantly better than that of traditional Hardinge approach (P<0.05). Prosthesis implantation will not be affected because exposure in the whole operation of the modified group is adequated.Conclution: A secure region were constituted from the surface projection of the MIB determined by minimum of the reference range to the most lateral protrusive point of the greater trochanter. We did not find any important nerves and vasculars in this region. The modified Hardinge approach will not damage the MIB and other important nerves and vasculars as it did not go beyong the secure region. It is an ideal method for hip arthroplasty within mang advantages.