前方進入人工股関節置換術における短外旋筋群温存率

Rate of Preservation of the Short Rotator Muscles in Total Hip Arthroplasty by a Direct Anterior Approach

　人工股関節置換術(THA)における前方進入法は，筋温存型の進入法であるが，大腿骨前方移動が不十分な場合，稀に短外旋筋群の切離が必要とされている．今回，前方進入法における短外旋筋群の温存率につき検討した．対象は当院で行った初回の人工股関節置換術(THA)470股である．内閉鎖筋腱の切離が8股，梨状筋腱の切離が4股であり，大腿筋膜張筋の損傷は7股であった．大腿骨前方移動を妨げる組織は後方関節包であり，これを切除するのみで，自験例では457(97.2％)股の症例で，短外旋筋群を切離せずに大腿筋膜張筋を損傷することなくTHAが可能であった．

　Total hip arthroplasty by the direct anterior approach allows implantation of total hip components without cutting any muscles around the hip.　However, it is sometimes necessary to release the short rotator muscles to be able to bring the proximal femur anteriorly.　We investigated the rate of preservation of the short rotator muscles in 470 primary total hip arthroplasty operations performed by the direct anterior approach.　The internal obturator tendons were resected in 8 hips, and the priformis tendons were resected in 4 hips.　In 7 hips, the tensor fasciae latae muscle was injured.　The short rotator muscles were preserved without damaging the tensor fasciae latae muscle in 457 (97.2%) of the hips in this series.