AHMET MURAT BÜLBÜL, SEMİH AYANOĞLU, Kahraman ÖZTÜRK, Yunus İMREN, CEM ZEKİ ESENYEL, Rıdvan YEŞİLTEPE, Hakan GÜRBÜZ

How reliable is the safe zone of hardinge approach for superior gluteal nerve?

Amaç: Anterolateral Hardinge yaklaşımı kalça artroplastisinde en sık kullanılan yaklaşımlardan biridir. Superior gluteal sinir, gluteus medius ve tensor fasya lata'nın abduktor mekanizmasının esas motor siniridir. Bu sinirin hasarlanması durumunda Trendelenburg belirtisi saptanmaktadır. Trendelenburg belirtisine maruz kalınmaması için "safe zone" denen kavram geliştirilmiştir. Safe zone diye adlandırılan bölgenin içinde superior gluteal sinir yoktur. Hardinge yaklaşımında çeşitli yazarlarca tariflenen safe zone kavramının güvenilirliğini değerlendirmeyi amaçladık. Hastalar ve Yöntemler: Çalışmamızı 10 taze kadavranın 19 kalçasında yaptık. Trokanter major'un (1/3 ön tarafındaki noktadan) superior gluteal sinire olan uzaklıklarını değerlendirdik. Bulgular: Trochanter major'ün 1/3 ön bölümüyle superior gluteal sinir arasındaki mesafeyi ortalama 4.4 mm olarak tespit ettik. Çalışmamızda bulduğumuz ortalama değer, daha önce değişik yazarlarca bildirilen değerlerden daha küçük olarak bulundu. Sonuç: Hardinge insizyonu ile total kalça artroplastisi yapılacak olgularda, safe zone olarak tanımlanan alanın çeşitli yazarlarca bildirilen 5 cm'nin altında olduğunu tespit ettik. Bu yaklaşımın kullanıldığı olgularda 5 cm'lik safe zone kavramına çok fazla güvenmememiz gerektiği sonucuna vardık.

Anahtar Kelimeler:

Artroplasti, Kaba etler, Kadavra, Ortopedik işlemler

Hardinge yaklaşımındaki safe zone superior gluteal sinir için ne kadar güvenilir?

Objectives: Anterolateral Hardinge approach is one of the most common approaches used for total hip arthroplasty. Superior gluteal nerve is the main motor nerve of abductor mechanism of gluteus medius and tensor fascia lata muscles, where the injury to this nerve manifests itself as Trendelenburg's sign. In order to prevent the occurrence of this sign, a concept was developed called as “safe zone”, where no superior gluteal nerve exists. Our aim was to evaluate the reliability of the concept of safe zone as previously described by many authors in Hardinge approach. Patients and Methods: Nineteen hips of 10 fresh cadavers were evaluated in this study. We measured the distance between 1/3 anterior of greater trochanter of femur and superior gluteal nerve. Results: We detected the distance between 1/3 anterior of greater trochanter of femur and superior gluteal nerve to be 4.4 cm. The mean value of distance we observed in our study was smaller than that reported in literature by various authors. Conclusion: We have detected that in cases where total hip arthroplasty will be performed through Hardinge incision, the area defined as safe zone was shorter than that described by various authors as 5 cm. We concluded that safe zone concept of 5 cm should not be relied on in cases where Hardinge approach is used.

Keywords:

Arthroplasty, Buttocks, Cadaver, Orthopedic Procedures,

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