耻骨联合分离经皮螺钉内固定术中交叉导针置入相关应用解剖学研究  

Anatomical study on the placement of cross-screw guide needle of percutaneous channel fixation of the pubic symphysis diastasis and the relationship between the entry point and vital structures around the pelvis

作　　者：杨德猛[1] 董曼 弋润欣 韩佳易 田振 钱佳蕾 贾豫昕 仵振基 张钧奎 马建军[7] 陈志国[7] Yang Demeng;Dong Man;Yi Runxin;Han Jiayi;Tian Zhen;Qian Jialei;Jia Yuxin;Wu Zhenji;Zhang Junkui;Ma Jianjun;Chen Zhiguo(Department of Emergency Trauma Surgery,PingXiang People's Hospital,Pingxiang 337000,China;Department of Medical Administration,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453003,China;School of Basic Medicine,Xinxiang Medical University,Xinxiang 453003,China;School of International Education,Xinxiang Medical University,Xinxiang 453003,China;the First Clinical College,Xinxiang Medical University,Xinxiang 453003,China;the Third Clinical College,Xinxiang Medical University,Xinxiang 453003,China;Laboratory of Gross Morphology of School of Basic Medicine,Xinxiang Medical University,Xinxiang 453003,China)

机构地区：[1]萍乡市人民医院急诊创伤外科,萍乡337000 [2]新乡医学院第三附属医院医务科,新乡453003 [3]新乡医学院基础医学院,新乡453003 [4]新乡医学院国际教育学院,新乡453003 [5]新乡医学院第一临床学院,新乡453003 [6]新乡医学院第三临床学院,新乡453003 [7]新乡医学院基础医学院大体形态学实验室,新乡453003

出　　处：《中华解剖与临床杂志》2023年第10期640-645,共6页Chinese Journal of Anatomy and Clinics

基　　金：萍乡市科技计划(2021PY058)。

摘　　要：目的探讨经皮通道螺钉内固定治疗耻骨联合分离时交叉螺钉导针置入情况及骨性进针点与盆腔周围重要结构的距离关系。方法选取10%甲醛固定的成人尸体标本13具,按照性别分为2组,男性组9具,年龄48~70岁(57.2±7.8);女性组4具,年龄51~63(58.0±5.3)岁。在骨盆两侧分别采用斜行骨性进针点和水平骨性进针点模拟经皮通道空心螺钉内固定手术操作。解剖暴露男性尸体标本的解剖结构精索、海绵体、阴茎根部中点、两侧耻骨结节、耻骨联合顶部中点、髂腹股沟神经、生殖股神经生殖支、阴茎背神经、两侧股动静脉和女性解剖标志点子宫圆韧带、两侧耻骨结节、耻骨联合顶部中点、髂腹股沟神经、生殖股神经生殖支、阴蒂背神经、两侧股动静脉。观察项目:(1)测量并比较不同性别间两侧水平导针、斜行导针的进针长度,水平导针与斜行导针之间的夹角,以及斜行针与3个解剖平面(矢状面、冠状面、水平面)的夹角。(2)分别测量两侧水平导针、斜行导针的骨性进针点与男性解剖标志点和女性解剖标志点的最短距离。对比男性与女性间水平导针、斜行导针的骨性进针点与两侧耻骨结节、耻骨联合顶部中点、髂腹股沟神经、生殖股神经生殖支,以及同侧股动静脉最短距离的差异。结果(1)女性水平和斜行导针进针长度分别为(69.46±4.52)和(59.48±7.60)mm、均大于男性的(57.70±7.70)和(50.76±10.19)mm,水平导针与斜行导针的夹角为30.69°±6.15°、小于男性的40.63°±10.30°,差异均有统计学意义(t=4.02、2.16、2.52,P值均<0.05)。女性斜行导针与矢状面的夹角为79.08°±7.50°、大于男性的58.07°±18.33°,与水平面的夹角为29.76°±6.08°、小于男性的38.27°±10.05°,差异均有统计学意义(t=2.10、2.21,P值均<0.05);而不同性别间斜行导针与冠状面的夹角差异无统计学意义(P>0.05)。(2)男性水平导针与斜行导针骨Objective The aim of this study was to explore the placement of cross-screw during percutaneous channel screw internal fixation for pubic symphysis diastasis and the distance relationship between the needle entry points and the vital structures around the pelvis.Methods Thirteen embalmed cadavers fixed with 10%formaldehyde were selected and divided into two groups according to gender:9 in the male group,aged 48-70(57.2±7.8)years old,and 4 in the female group,aged 51-63(58.0±5.3)years old.Oblique and horizontal needle entry points were selected on each side of the pelvis,and the operation was simulated.The structures of male cadaveric specimens,including the spermatic cord,the corpus cavernosum,the midpoint of the penile root,the pubic tubercle on both sides,the midpoint of the top of the pubic symphysis,the ilioinguinal nerve,the genital branch of the genitofemoral nerve,the dorsal penile nerve,and the femoral artery and vein on both sides and the structures of female cadaveric specimens,including the uterine round ligament,the pubic tubercle on both sides,the midpoint of the top of the pubic symphysis,the ilioinguinal nerve,the genital branch of the genitofemoral nerve,the dorsal clitoral nerve,and the femoral artery and vein on both sides were anatomically exposed.Observation items included the following:(1)To measure and compare the length of the horizontal and oblique guide needles'insertion part,the angle between the horizontal and oblique guide needles,and the angles between the oblique needle and the three anatomical planes,namely,sagittal,coronal,and horizontal planes between the genders.(2)To measure the shortest distance between the entry point of the horizontal and oblique guide needles and the male anatomical landmark points and the female points on both sides,respectively,and compare the differences between genders in the shortest distances between the entry points of the horizontal and oblique guide needles and the midpoint of the pubic tuberosity,the top of the pubic symphysis,the ilioinguinal ne

关 键 词：耻骨联合分离 骨折固定术 内 克氏针 应用解剖 

分 类 号：R687[医药卫生—骨科学] R322[医药卫生—外科学]