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1、. . . .1、术前准备The anterolateral approach (Watson-Jones) to the proximal femur, through the interval between glutei and tensor fascia lata provides somewhat limited access to the hip joint along with the lateral proximal femur. With well-positioned retractors and adequate soft-tissue releases, it is p
2、ossible to perform open reduction of displaced femoral neck fractures (31-B), and some femoral head fractures (31-C).A more medial approach to the hip joint (Iliofemoral or Smith-Peterson), medial to the tensor fascia lata, may improve access to the femoral head and neck, but for fixation of the nec
3、k with a sliding hip screw, a separate lateral incision will be required.前外侧入路即W-J入路显露股骨近端，通过臀肌与阔筋膜张肌之间有限显露髋关节及股骨近端。在牵开器帮助和充分的软组织松解的情况下，可以用来复位股骨颈骨折（31-b），有时也可以复位些股骨头骨折（31-C）。一个更靠内侧显露髋关节的切口如Iliofemoral切口或S-P切口，在阔筋膜张肌内侧，可以提供显露股骨头和股骨颈，但是如果用DHS固定股骨颈骨折，则需要一个独立的外侧切口。2、皮肤切口Start the slightly anteriorly cur
4、ved skin incision about 7-10 cm proximal of the lateral part of the greater trochanter (directed towards the tubercule of the iliac crest the posterior landmark of tensor fascia lata origin). Distally, the incision extends along the femur about 10 cm below the greater trochanter.在股骨大转子上约7-10cm外侧略前方处
5、行轻微弯曲皮肤切口（方向从髂结节到阔筋膜张肌起始部），向远端延伸至股骨干（大粗隆下10cm处）。3、显露阔筋膜张肌Expose the fascia lata sharply. Incise the fascia lata over the femur and extend this incision proximally along the posterior border of the tensor fascia lata.锐性显露阔筋膜张肌。在股骨处切开阔筋膜张肌并向近端沿着阔筋膜张肌后侧边界锐性分离。4、深层分离With the greater trochanter and the g
6、luteus medius muscle exposed, retract the tensor fascia lata anteriorly and the gluteus medius muscle posteriorly. Expose the interval between the gluteus medius and the tensor fascia lata and extend it proximally over the hip joint. This can be best done by blunt dissection.Be aware of vessels runn
7、ing across this interval. They require ligation or cautery.显露大粗隆及臀中肌，将阔筋膜张肌向前方牵开，臀中肌向后方牵开。钝性分离臀中肌与阔筋膜张肌之间间隙向近端延伸至髋关节。注意此间隙的血管术，可以结扎或电凝止血。5、显露髋关节囊Place a Hohmann retractor into the bone proximal to the hip capsule. Additional retractors anteriorly and posteriorly will open the dissected interval.Exte
8、rnal rotation of the leg improves access to the hip capsule.在髋关节股骨头部放置Hohmann拉钩，另外在前和后方各放置一个拉钩， 可以显露解剖间隙。外旋大腿将有助于显露髋关节囊。6、松解股外侧肌The origin of the vastus lateralis muscle should be released from the anterior inferior trochanteric region to expose the underlying hip capsule. Retract the muscle inferio
9、rly.Adjust the retractors as necessary, and debride periarticular fat to expose the hip capsule.从大转子前下方剥离股外侧肌起点显露潜在的关节囊，向下牵拉肌肉。视需要调整拉钩，清除关节周围的脂肪。7、打开关节囊Make an T-shaped incision in the capsule, 关节囊做一个T型切口8、打开关节囊and place two retraction sutures, anteriorly and posteriorly. Protect the acetabular labr
10、um.This capsulotomy shows the anterior femoral head and neck. Lateral traction and repositioning of the leg can improve visualization.The incison can be prolonged distally over the proximal vastus lateralis to allow insertion of screws or DHS for femoral neck fracture fixation.在关节囊前方和后方置入两根缝合线，以保护髋臼
11、。此关节囊切开术可以显露股骨头和颈前面，外侧牵开或旋转大腿可以增加显露。此切口可以沿股外侧肌延长，以便拧入股骨颈螺钉或DHS来固定股骨颈骨折。9、闭合伤口Perform a meticulous debridement of all soft tissues before starting wound closure.Remove necrotic tissue and irrigate the entire wound to decrease the risk of periarticular ossification. Insert suction drains if desired.Cl
12、ose the fascia lata incision with interrupted sutures. Close the subcutaneous tissue and skin as desired.闭合伤口前仔细清除所有软组织。清除坏死组织并冲洗整个伤口以减少关节周围骨化形成，如果必要可以下负压吸引装置。间断缝合阔筋膜，缝合皮肤及皮下组织。1. 若不给自己设限，则人生中就没有限制你发挥的藩篱。2. 若不是心宽似海，哪有人生风平浪静。在纷杂的尘世里，为自己留下一片纯静的心灵空间，不管是潮起潮落，也不管是阴晴圆缺，你都可以免去浮躁，义无反顾，勇往直前，轻松自如地走好人生路上的每一步3. 花一些时间，总会看清一些事。用一些事情，总会看清一些人。有时候觉得自己像个神经病。既纠结了自己，又打扰了别人。努力过后，才知道许多事情，坚持坚持，就过来了。4. 岁月是无情的，假如你丢给它的是一片空白，它还给你的也是一片空白。岁月是有情的，假如你奉献给她的是一些色彩，它奉献给你的也是一些色彩。你必须努力，当有一天蓦然回首时，你的回忆里才会多一些色彩斑斓，少一些苍白无力。只有你自己才能把岁月描画成一幅难以忘怀的人生画卷。学习参考
