| Objective:The existing text and literature of short external rotators in the proximal femur insertion location mostly qualitative description and there is a big variation,this research through the specimen autopsy on the corpses of hips,with each muscle of the short external rotators in the proximal insertion position measurement and quantitative description,for the traditional total hip replacement with short external rotators in the process of restoration and reconstruction and minimally invasive total hip replacement is effective to avoid damage of short external rotators provide detailed anatomical basis.Method:In this study,10 adult hip joint cadavers fixed with formalin,5 males and 5females,aged 50-81 years,with a median age of 63 years,were selected to remove the skin,fat,fascia and other soft tissues of the hip cadavers,and to expose the piriformis muscle,superior gemellus,obturator internus,inferior gemellus,obturator externus,and quadratus femoris.A coordinate system is established on the inner side of the greater trochanter.A horizontal line along the highest point of the base of the femoral neck is defined as the X-axis.A line perpendicular to the X-axis is defined as the Y-axis along the front end of the greater trochanter.The position of each muscle stop on the medial side of the greater trochanter can be obtained by measuring the distance between the leading edge and the trailing edge of each muscle stop to the Y-axis/X-axis(width of the greater trochanter)×100%,and the distance between the upper edge and the lower edge of the muscle stop to the X-axis/Y-axis(height of the greater trochanter)×100%.Results:The anterior and posterior edges of the piriformis muscle are56.2±9.6%-77.2±10.5% in the axis of the medial greater trochanter coordinate systemX,and the upper and lower edges of the piriformis muscle are 63.6±9.7%-56.2±10.4%in the Y-axis of the medial greater trochanter coordinate system.The anterior and posterior edges of the combined tendon(superior gemellus,obturator internus,inferior gemellus)were 28.9±8.4% to 53.1±9.1% in the medial greater trochanteric coordinate system,and the upper and lower edges of the combined tendon were 60.1±9.3% to23.8±8.7% in the medial greater trochanteric coordinate system.The range of attachment points of the obturator externus muscle on the medial side of the greater trochanter is as follows: the leading and trailing edges of the obturator externus are62.3± 5.1-76.01 ±6.4% in the coordinate system of the medial part of the greater trochanter,and the upper and lower edges of the obturator externus are 8.9±9.1%--16.1±10.4% in the coordinate system of the medial part of the greater trochanter.Conclusions:1.The insertion position of piriformis muscle at the proximal end of femur is the posterior upper part of the medial surface of the greater trochanter,and the insertion position of the conjoint tendon(superior gemellus,obturator internus,inferior gemellus)at the proximal end of femur is the middle part of the medial surface of the greater trochanter,near the fossa trochanter.The insertion of the obturator externus at the proximal end of the femur is posterior and inferior to the medial surface of the greater trochanter.The insertion position of quadratus femoris is the intertrochanteric crest.There was a large variation in the position of the proximal femoral insertion of the short external rotators.2.The accurate grasp of the position of the short external rotators at the proximal end of femur will provide anatomical basis for the effective repair and reconstruction of the short external rotators in the traditional posterolateral approach.3.In the process of minimally invasive total hip arthroplasty,the conjioned tendon and piriformis muscle have a greater risk of injury,especially the conjioned tendon.4.Due to the large variation of the short external rotators at the proximal end of the femur,the injury of some short external rotators is inevitable in the process of minimally invasive total hip arthroplasty. |
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