改良腹直肌旁切口入路前路钢板固定骶骨骨折的解剖学研究  

Modified pararectus abdominis approach for anterior plate fixation of sacral fracture:a clinical anatomy study

作　　者：林羲疆 李严兵 黄华军 郭浩 温志深 陈博韬 周奇 陈柱宏 曾参军 Lin Xijiang;Li Yanbing;Huang Huajun;Guo Hao;Wen Zhishen;Chen Botao;Zhou Qi;Chen Zhuhong;Zeng Canjun(Department of Orthopedics,The Third Affiliated Hospital to Southern Medical University Academy of Orthopedics of Guangdong Province,Guangzhou 510630,China;Department of Human Anatomy,School of Basic Medical Sciences,Southern Medical University Guangdong Provincial Key Laboratory of Medical Biomechanics,Guangzhou 510515,China)

机构地区：[1]南方医科大学第三附属医院,广东省骨科研究院骨科,广州510630 [2]南方医科大学基础医学院人体解剖学教研室,广东省医用生物力学重点实验室,广州510515

出　　处：《中华创伤骨科杂志》2021年第11期969-974,共6页Chinese Journal of Orthopaedic Trauma

基　　金：广东省自然科学基金项目(2018A0303130242);广东省科技计划项目(2018B090944002)。

摘　　要：目的探讨经改良腹直肌旁切口入路前路钢板固定治疗骶骨骨折的安全性及可行性。方法收集新鲜成人尸体标本5具(男3具,女2具),采用改良腹直肌旁切口入路对同一尸体骨盆一侧行大体解剖,熟悉入路的解剖结构。另一侧骨盆模拟术中操作,显露骶骨前方结构,进行解剖学观察,重点观察入路能显露的解剖范围及腰骶干神经、髂血管所在位置及走行,测量、记录相关解剖数据。结果①显露范围:向内侧可显露至S1椎体对侧缘,切口向头侧延伸可显露L5椎体,向真骨盆内可显露至S1孔,外侧显露同传统腹直肌旁入路。②采用改良腹直肌旁切口入路可直视下对腰骶丛神经(L4至S1)探查和减压(包括S1孔扩大成形术),解除来自前方卡压骨折块、骨折断端及增生骨痂对神经的压迫。③L5、S1前方存在一安全手术操作区,可将钢板安全地固定于S1椎体上。④从骨膜下将腰骶干神经提起,距骶骨翼的最大距离平均1.4 cm(1.2~1.5 cm),可安全地将钢板从骨膜下放置至S1椎体上固定骨折。结论改良腹直肌旁切口入路对于骶前区腰骶丛神经(L4至S1)探查、减压具有显著的视野及操作优势,其方法安全、有效,是行腰骶神经探查减压的可行入路。同时,可以对骶骨骨折的移位进行直视下复位,将钢板固定于S1椎体,沿骶骨翼跨骶髂关节至髂骨,拓宽了骶前钢板向内固定的安全范围。Objective To investigate the safety and feasibility of modified pararectus abdominis approach in the anterior plate fixation of sacral fractures.Methods In 5 fresh adult cadavers(3 males and 2 females),gross anatomy was performed on one pelvic side using a modified pararectus abdominis approach to clarify the anatomical structures around the approach.On the other side of the pelvis,the anterior structures of the sacrum were exposed in simulated anterior plate fixation of sacral fracture via the modified pararectus abdominis approach.The exposed anatomic range of the approach,and the locations and courses of lumbosacral trunk nerve and iliac vessels were observed and recorded.Results(1)The modified pararectus abdominis approach exposed the whole S1 vertebral body from the sacroiliac joint to the medial side,the L5 vertebral body cephalally,the S1 foramina in the true pelvis,and the same structures laterally as a traditional pararectus abdominis approach did.(2)Via the modified pararectus abdominis approach,exploration and decompression of the lumbosacral plexus(from L4 to S1)(including S1 foraminoplasty)were performed under direct vision to decompress the nerve entrapment from anterior compressed fracture fragments and hyperplastic callus.(3)There was a safe surgical area in anterior L5 and S1 where a plate could be safely fixed to the S1 vertebral body.(4)Since the maximum vertical distance from the lumbosacral trunk nerve lifted above the periost to the sacral ala was 1.4 cm(range,from 1.2 to 1.5 cm),a plate could be safely placed from the subperiosteum to the S1 vertebral body to fix the fracture.Conclusions The modified pararectus abdominis approach is safe and feasible for exploration and decompression of lumbosacral nerves in the anterior sacral region(from L4 to S1)because it has significant advantages in vision and operation.It also broadens the range of anterior sacral plate fixation because a sacral fracture displacement can be reduced under direct vision and a plate can be fixated to the S1 vertebral bo

关 键 词：腹直肌 解剖学 局部 骶骨 前路入路 

分 类 号：R687.3[医药卫生—骨科学]