直接后方入路手术治疗髋臼后部骨折的解剖学研究  

Anatomic study of direct posterior approach in treatment of posterior acetabular fractures

作　　者：黄复铭 郑秋宝 詹潇锐 李涛 杨诚 黄海 刘源城 温湘源 樊仕才 HUANG Fu-ming;ZHENG Qiu-bao;ZHAN Xiao-rui;LI Tao;YANG Cheng;HUANG Hai;LIU Yuan-cheng;WEN Xiang-yuan;FAN Shi-cai(Department of Orthopaedics,the Third Affiliated Hospital of Southern Medical University,Guangzhou,Guangdong 510630,China)

机构地区：[1]南方医科大学第三附属医院创伤骨科

出　　处：《中国骨与关节损伤杂志》2019年第10期1015-1018,共4页Chinese Journal of Bone and Joint Injury

基　　金：国家自然科学基金（81772428）;广东省前沿与关键技术创新专项资金（重大科技专项）项目计划（2015B010125006）;广东省教育厅高水平大学建设经费南方医科大学临床研究启动项目（LC2016ZD032）

摘　　要：目的测量髋部直接后方入路的安全显露范围,并评价通过该入路手术治疗髋臼后部骨折的安全性。方法取新鲜成人尸体标本6具,尸体双侧臀部均采用直接后方入路模拟手术操作,观察髋臼后部显露范围,测量臀上神经血管束及坐骨神经相关解剖参数。结果直接后方入路显露范围是整个髋臼后壁、部分关节囊及大部分髋臼后柱(坐骨大孔上缘至坐骨棘),切口长度为(9.82±0.52)cm。臀上动脉、臀上静脉、臀上神经与坐骨大切迹相交处距坐骨大切迹顶点的距离分别为(10.55±1.73)、(15.02±1.86)、(3.00±1.09)mm。坐骨神经外侧缘与梨状肌上缘、梨状肌下缘相交处距坐骨大切迹顶点的距离分别为(18.85±5.31)、(28.06±4.80)mm。坐骨神经在梨状肌下缘处的宽度为(15.96±2.10)mm,梨状肌牵拉后坐骨神经移动距离为(17.79±2.30)mm,坐骨棘至坐骨大切迹顶点距离为(47.43±5.20)mm。结论直接后方入路手术治疗髋臼后部骨折能够在不离断外展肌、外旋肌群的情况下经臀中肌与梨状肌间隙直接显露髋臼后部结构,既能为手术提供足够的安全显露范围,也能避免损伤周围神经、血管组织,可作为临床显露髋臼后部的又一备选手术入路。Objective To measure the safe exposure rang of the acetabulum via direct posterior approach and to evaluate its safety in the treatment of posterior acetabular fractures. Methods Six fresh adult cadaver specimens were used. The direct posterior approach was performed on both sides of the buttocks of each cadaver to simulate the surgical procedure, in order to observe the exposure rang of the posterior acetabulum. The anatomical measurement of the superior gluteal neurovascular bundle and the sciatic nerve were performed. Results The exposure of the entire acetabular posterior wall, partial hip capsule and the great mass of the posterior column(from the superior margin of the greater sciatic foramen to the sciatic spine)was achieved by the direct posterior approach, with its incision length of 9.82±0.52 mm. The distances from the intersection of the greater sciatic notch with the superior gluteal artery, the superior gluteal vein, the superior gluteal nerve, to the apex of the greater sciatic notch were 10.55±1.73 mm, 15.02±1.86 mm, 3.00±1.09 mm respectively. The distances from the intersection of the lateral edge of the sciatic nerve with the upper and lower edges of the piriformis, to the apex of the greater sciatic notch were 18.85 ±5.31 mm, 28.06 ±4.80 mm respectively. The width of the sciatic nerve at the lower edge of the piriformis was15.96±2.10 mm. The mobile distance of the sciatic nerve after stretching with the piriformis was 17.79±2.30 mm. The distance from the sciatic spine to the apex of the greater sciatic notch was 47.43±5.20 mm. Conclusion The direct posterior approach for posterior acetabular fractures can directly expose the posterior aspect of the acetabulum through gluteus medius-piriformis interspace without breaking the abductor and external rotator muscles. It can provide adequate and safe exposure for surgery,avoid iatrogenic damage to the peripheral nerve, vessel and tissue. Therefore, the direct posterior approach can be seen as an alternative surgical approach for the treatment

关 键 词：髋臼后壁骨折 髋臼后柱骨折 直接后方入路 臀上神经血管束 坐骨神经 

分 类 号：R687.3[医药卫生—骨科学]