Objective: To review the research on different surgical approaches and MRI evaluation of total hip arthroplasty (THA), to clarify the possible muscle damage caused by different approaches, and to help clinicians avoid intraoperative muscle damage and identify the causes of certain muscle-related complications after operation.
Methods: The research literature on different surgical approaches and MRI evaluation of THA at home and abroad was extensively reviewed to summarize the MRI performance of the posterior approach, modified direct lateral approach, direct anterior approach, and minimally invasive anterolateral approach (also called Orthopadische Chirurgie Munchen approach).
Results: The traditional posterior approach mainly damages the short external rotator muscle group and increases the incidence of postoperative dislocation; the piriformis-keeping posterior approach significantly improves the quality of the pyriformis tendon in the postoperative period, but it may lead to damage to the intrapelvic portion of the piriformis muscle. The modified direct lateral approach mainly damages the gluteus medius muscle, which increases the risk of postoperative claudication. The direct anterior approach mainly damages the vastus tensoris muscle and may result in damage to the short external rotator muscle group and the muscles around the incision. The minimally invasive anterolateral approach primarily damages the superior gluteal nerve, which subsequently leads to denervation of the broad fascial tensor fasciae latae, and this approach may also result in injury to the gluteus medius and gluteus minimus muscles. The muscle damage status significantly affects prognosis, and the minimally invasive approach is more suitable for elderly patients.
Conclusion: MRI can clarify the different types of muscle damage caused by different surgical approaches. Minimally invasive approaches can reduce muscle damage and improve postoperative function compared with traditional approaches, and can benefit elderly patients more, but due to the small field, forcing to expand the surgical field will lead to unintended muscle damage and reduce postoperative function.
目的: 对人工全髋关节置换术（total hip arthroplasty，THA）不同手术入路及MRI评估研究进行综述，明确不同手术入路可能造成的肌肉损伤，帮助临床医生术中进行规避并在术后识别某些肌肉相关并发症的成因。.
方法: 广泛查阅国内外有关THA不同手术入路及MRI评估的研究文献，总结后入路、改良直接外侧入路、直接前入路以及微创前外侧入路（又称慕尼黑骨外科入路）的MRI表现。.
结果: 传统后入路主要损伤短外旋肌群，增大术后脱位率；保留梨状肌后入路可以明显改善术后梨状肌肌腱质量，但可能导致梨状肌盆腔内部分损伤。改良直接外侧入路主要损伤臀中肌，增大术后跛行风险。直接前入路主要损伤阔筋膜张肌，以及可能会造成短外旋肌群和切口周围肌肉损伤。微创前外侧入路主要损伤臀上神经，继而导致阔筋膜张肌去神经化，还可能导致臀中肌和臀小肌损伤。肌肉损伤情况明显影响THA预后，微创入路更适用于老年患者。.
结论: 通过MRI可以明确不同手术入路造成的不同类型肌肉损伤。相比传统入路，微创入路可以减少肌肉损伤、改善术后功能，且老年患者受益更多；但由于微创入路术野较小，强行扩大术野将导致意料之外的肌肉损伤，影响术后功能恢复。.
Keywords: MRI; Total hip arthroplasty; muscle damage; surgical approach.