"死亡冠"血管的发生率及临床意义  

The incidence and clinical significance of corona mortis vessel

作　　者：仇道迪 周东生[1] 李连欣[1] 傅佰圣[1] 董金磊[1] 李庆虎[1] Qiu Daodi;Zhou Dongsheng;Li Lianxin;Fu Baisheng;Dong Jinlei;Li Qinghu(Department of Orthopaedics,Shandong Provincial Hospital Affiliated to Shandong University,Ji'nan 250021,China)

机构地区：[1]山东大学附属省立医院,济南250021

出　　处：《中华骨科杂志》2019年第5期284-290,共7页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金面上项目(81672156);山东省重点研发计划项目(2017GSF18112).

摘　　要：目的探讨Stoppa入路下"死亡冠"血管的发生率及临床意义。方法前瞻性分析2015年12月至2017年12月,应用Stoppa入路治疗48例骨盆髋臼骨折患者术中资料,男36例,女12例;年龄30~67岁,平均(47.2±8.2)岁;单侧骨盆、髋臼骨折44例,双侧骨盆、髋臼骨折4例,共52侧半骨盆。48例患者中,骨盆骨折6例,髋臼骨折40例,骨盆合并髋臼骨折2例。髋臼骨折按照Judet-Letournel分型:前柱骨折6例,前柱伴前壁骨折4例,前柱伴后半横骨折2例,横断骨折4例,"T"形骨折6例,双柱骨折20例。骨盆骨折按照Tile分型:B1型2例,B3型2例,C1型2例,C2型2例。受伤至手术时间为5~16 d,平均为(8.3±2.8)d。所有患者均应用Stoppa入路进行前路复位固定,术中探查闭孔血管与髂外血管或腹壁下血管之间的耻骨吻合支——"死亡冠"血管并测量记录该血管的直径、数量、动静脉类型、发生率及"死亡冠"血管行经耻骨上缘结合处至耻骨联合上边缘的距离等指标。结果在52侧半骨盆中,存在吻合血管46侧,无吻合血管6侧,"死亡冠"血管发生率为88.5%(46/52)。其中36例为静脉型,发生率为78.3%(36/46);8例为动脉型,发生率为17.4%(8/46);2例为混合型,发生率为4.3%(2/46)。"死亡冠"静脉血管直径1.8~3.7 mm,平均(2.9±0.5)mm;动脉血管直径2.4~3.0 mm,平均(2.7±0.3)mm。"死亡冠"血管至耻骨联合的距离为48~71 mm,平均(56.9±5.8)mm。结论"死亡冠"血管广泛存在,Stoppa入路下发现该血管的发生率约为88.5%。在临床治疗骨盆、髋臼骨折显露耻骨支时需注意仔细分离"死亡冠"血管,尤其采用髂腹股沟入路时更需谨慎,以免损伤引起大出血。Objective To explore the incidence and clinical significance of corona mortis vessels. Methods From December 2015 to December 2017, 48 patients with pelvic acetabular fractures were treated with the Stoppa approach, including 36 males and 12 females, aged 30 to 67 years, with an average age of 47.2±8.2 years. There were 52 sides of hemipelvis in the all including 44 cases of unilateral pelvic acetabular fractures and 4 cases of bilateral pelvic acetabular fractures. In the 48 patients, there were 6 pelvic fractures, 40 acetabular fractures and 2 pelvic combined with acetabular fractures. According to Judet-Letournel classification: there were 6 cases of anterior column fracture, 4 cases of anterior column with anterior wall fracture, 2 cases of anterior column with posterior transverse fracture, 4 cases of transverse fracture, 6 cases of "T" shape fracture and 20 cases of double column fracture. According to Tile classification, there were 2 cases of B1 type, 2 cases of B3 type, 2 cases of C1 type, and 2 cases of C2 type. The time from injury to surgery was 5 to 16 days, with an average of 8.3±2.8 days. All patients were treated with the Stoppa approach for reduction and fixation. The incidence, number and type of corona mortis vessels across the superior pubic branch, and the diameter and the distance between the vessels and the pubic symphysiswere detected and recorded. Results In the 52 hemi pelvis, there were 46 sides with an anastomotic blood vessel, and no anastomotic blood vessel was found in 6 sides, with the incidence of corona mortis vessels of 88.5%(46/52). Among them, 36 cases were venous type, with the incidence of 78.3%(36/46);8 cases were arterial type, with the incidence of 17.4%(8/46);2 cases were mixed type, with the incidence of 4.3%(2/46);corona mortis venous blood vessel diameter was 1.8-3.7 mm, with an average of 2.9±0.5 mm;arterial blood vessel diameter was 2.4-3.0 mm, with an average of 2.7±0.3 mm;the distance between the vessels and the pubic symphysis was 48-71 mm, with an average of

关 键 词：骨盆 髋臼 骨折 血管 

分 类 号：R687.3[医药卫生—骨科学]