Hip Arthroscopy Portal Placement | Hip Anatomy | Hip Specialist скачать в хорошем качестве

Hip Arthroscopy Portal Placement | Hip Anatomy | Hip Specialist

http://www.nsmoc.com/ There are three standard portal positions: anterior, anterolateral and posterolateral. The lateral two portals are positioned over the superior margin of the greater trochanter at its anterior and posterior boarder. The anterior portal is sided at the intersection of a sagittal line drawn distally from the anterior/superior illiac spine and a transverse line drawn across the superior tip of the greater trochanter. It is directed approximately 45 degrees cephalad and 30 degrees towards the mid-line. At the level of the anterior portal, the lateral femoral cutaneous nerve is typically divided into 3 or more branches. One of these branches will always lie close to the portal and is especially vulnerable to laceration if the skin incision is carried too deeply. The canula penetrates the sartorius and rectus femoris before entering the anterior capsule. The direction of the portal runs roughly tangential to the axis of the femoral nerve, lying only slightly closer at the level of the capsule with a reported average minimum distance of 3.2 cm. The anterolateral portal lies most centrally in the safe zone for arthroscopy. It penetrates the gluteus medius before entering the lateral aspect of the capsule at its anterior margin. The superior gluteal nerve on the deep surface of the gluteus medius courses transversely above the lateral two portal, approximately 4.4 cm. The posterolateral portal passes above the posterior boarder of the greater trochanter. The portal penetrates the gluteus medius and minimus, entering the lateral capsule at its posterior margin, superior and anterior to the piriformis tendon. It is closes to the sciatic nerve at the capsule with an average distance of 2.9 cm. Neutral rotation of the portal placement is important. If the hip is externally rotated, the greater trochanter moves posteriorly and could cause the posterolateral portal to pass closes to the sciatic nerve during placement.