Kocher-Langenbeck入路治疗髋臼后壁后柱骨折的临床解剖学研究  

Clinical Anatomy Study of the Kocher-Langenbeck Approach for the Acetabular Posterior Column Fracture

作　　者：刘照华[1] 王大平[1] 杨欣建[1] 刘黎军[1] 陈宏贤[1] 李文翠[1] 刘健全[1] 杨金星[1] 

机构地区：[1]深圳市第二人民医院创伤骨科,深圳518000

出　　处：《中国现代手术学杂志》2010年第6期433-436,共4页Chinese Journal of Modern Operative Surgery

基　　金：深圳市科技计划重点项目(200701015)

摘　　要：目的 研究Kocher-Langenbeck（简称K-L）入路中臀上动脉深下支、坐骨神经及髋臼后柱切面解剖特点,为安全放置重建钢板螺钉内固定治疗髋臼后壁后柱骨折提供依据.方法 采用正常国人骨盆标本17具34侧,以K-L入路显露髋臼后柱,观测臀上动脉深下支及坐骨神经的移动范围,以后柱长轴为参考予髋臼后柱切片,对各切面进行观测.结果 臀上动脉深下支主干长度（52.56±3.48）mm, 起始直径（2.44±0.28）mm;伸膝位时,坐骨神经在切断外旋肌群后可水平移位（6.58±2.12）mm;后柱横切面为底角约56.6°～62.4°的 等腰三角形.临床应用1例,采用K-L入路治疗髋臼骨折,疗效满意.结论 臀上动脉深下支需在放置后柱重建钢板前探查处理;坐骨神经在切断外旋肌群后仍与后柱关系密切,手术过程容易伤及;后柱髋臼区切面按锐角等腰三角形处理,可帮助判断安全钉道的角度及深度.Objective To investigate the anatomic characters of the deep inferior branch of the superior gluteal artery and the sciatic nerve,the thickness and the geometric characters of the acetabular posterior column,and to provide data for placing acetabular posterior column reconstructive plates.Methods Seventeen adult pelvic specimens were harvested in this study.The acetabular posterior columns and the sciatic nerves were exposed from the K-L approach.The length and the diameter of the deep inferior branch of the superior gluteal artery and the sciatic nerve movement space were measured,and a serial cross-sections of the posterior column were made and measured.Results The length of the deep inferior branch of superior gluteal artery was（52.56±3.48）mm,and the diameter of the beginning was（2.44±0.28）mm.The sciatic nerve could move about 6mm after the cutting off the extortor.The shadow of the cross-sections of the posterior column looked like the isosceles triangle that the antapical horn was from 56.6° to 62.4°.Conclusions The deep inferior branch of superior gluteal artery should be handled before the placement of the reconstructive plate.The sciatic nerve is very close to the posterior column even after the cutting off the extortor.Dealing the shadow of the cross-sections as the triangle can help to judge the safe entry angle of inclination and the safe depth of the screw path.

关 键 词：髋骨折 髋臼 手术径路 解剖学 局部 骨折固定术 内固定器 

分 类 号：R687.3[医药卫生—骨科学]