单一改良腹直肌旁切口治疗骨盆后环损伤合并对侧前环损伤的解剖研究  

Anatomical study of posterior pelvic ring injury combined with contralateral anterior pelvic ring injury treated with modified pararectus abdominis incision

作　　者：陈柱宏 李严兵 黄华军 林羲疆 曾参军 Chen Zhuhong;Li Yanbing;Huang Huajun;Lin Xijiang;Zeng Canjun(Department of Foot and Ankle Surgery,Center for Orthopaedic Surgery,The Third Affiliated Hospital of Southern Medical University,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骨科医学中心足踝外科,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：《中国临床解剖学杂志》2023年第6期633-639,共7页Chinese Journal of Clinical Anatomy

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：目的解剖实验验证单一改良腹直肌旁切口治疗骨盆后环损伤合并对侧前环损伤的安全性及可行性。方法收集大体标本3具,采用改良入路单切口显露同侧前后环并延伸至对侧前环,观察显露范围及对侧死亡冠、髂血管,收集相关数据,模拟复位固定,评价安全性及有效性。结果显露范围:同侧内侧可至腹中线,后内侧可至S_(1)椎体对侧缘,头侧延伸至L_(5)椎体,真骨盆内可达S_(1)孔,外侧显露同经典入路;对侧外侧可至对侧髂耻隆起,头侧可至对侧四方体上前方,深部达闭孔外上1/2。改良入路可显露同侧骶髂关节及对侧耻骨上支,直视下处理后环及对侧前环损伤。切口总长(7.84±0.18)cm,对侧死亡冠、髂前上棘与耻骨联合的距离分别为(57.07±1.04)、(67.43±0.87)cm。结论单一改良腹直肌旁切口治疗同侧骨盆后环损伤合并对侧前环损伤安全、有效,有显著的微创及视野优势。Objective To validate the safety and feasibility of the modified pararectus abdominis approach in the treatment of posterior pelvic ring injury and contralateral anterior ring injury in one incision through anatomical experimentation.Methods Three specimens of cadaver were collected.A modified pararectus abdominis approach with a single incision was used to expose the ipsilateral anterior and posterior pelvic rings and extend to the contralateral anterior pelvic ring.The safety and efficacy of this method was evaluated by assessing the extent of exposure and potential risks to adjacent structures,such as the iliac vessels and corona mortis in the contralateral side,examining the structures exposed,simulating fixation,and collecting relevant data and images.Results The ipsilateral exposure range:This approach extended medially to the midline of the abdomen,reached posteriorly the contralateral edge of the S_(1) vertebral body,while anteriorly extended to the L_(5) vertebral body,while it reached the S_(1) foramen in the true pelvis when exposing caudally.The contralateral exposure range:the contralateral side of the incision could be accessed until reaching the opposite iliopubic eminence.Heading towards the quadrilateral area of acetabulum could expose the medial surface of the contralateral anterior upper part of it,and the depth of the approach extended to upper lateral half of the inner surface of the obturator formamen.Furthermore,the modified approach was effective in revealing the ipsilateral sacroiliac joint and the contralateral pubic ramus while treating the injury of the ipsilateral posterior and contralateral anterior rings under direct visualization.The total incision length was measured at(7.84±0.18)cm,and the distances from the pubic symphysis to the contralateral corona mortis and anterior superior iliac spine recorded as(57.07±1.04)cm and(67.43±0.87)cm,respectively.Conclusions The use of modified pararectus abdominis approach for treating ipsilateral posterior pelvic ring injury and contralater

关 键 词：改良腹直肌旁切口 解剖学 局部 耻骨上支 前方入路 

分 类 号：R323.3[医药卫生—人体解剖和组织胚胎学]