改良Stoppa入路髋臼后柱的解剖学研究和临床治疗效果分析
发布时间：2018-09-07 18:02
【摘要】：目的一、通过骨盆标本解剖研究,记录和测量骨盆内坐骨大切迹后方解剖结构与坐骨大切迹后方的关系。为临床使用改良Stoppa入路和应用髂坐钢板技术提供参考依据。二、综合文献结果,比较改良Stoppa入路和髂腹股沟入路的临床治疗效果。材料和方法第一部分1.骨盆标本由南方医科大学解剖教研室提供8个骨盆标本,6男2女。2.采用改良Stoppa入路,显露四边体、后柱内壁、坐骨大切迹。辨认并测量骨盆内相关解剖学参数。3.使用SPSS行统计学分析第二部分1.在PUBMED搜索英文文献,关键词:在Pubmed上收集髂腹股沟入路和Stoppa入路比较的相关文献。关键词:((“Stoppa Approach”OR“Anterior Approach”))AND“Acetabular fracture"2.纳入标准为:1.病人普遍年龄大于15岁,小于65岁,不包括儿童和老年人髋臼骨折治疗;2.文献为病例分析资料,比较指标需涉及手术时间和出血量,骨折复位率,并发症等;3.不包括骨盆骨折、腹直肌旁入路以及特定骨折的治疗病例;4.治疗方法包括改良Stoppa入路或改良Stoppa入路与髂腹股沟入路的治疗病例分析;5.英文文献;6.2010年以后发表的文献。3.收集文献资料数据,总结并分析结果。结果1.改良Soppa入路髋臼后柱解剖测量1.1死亡冠血管6例均可见单根死亡冠血管,均为静脉型,从腹壁下静脉发出。1例双侧未见死亡冠血管和变异闭孔血管。1例死亡冠血管缺如,由变异的闭孔血管代替(图1-1)。死亡冠血管距离耻骨联合48±5.5mm。变异闭孔血管为单根动脉和单根静脉,从髂内血管主干发出。变异闭孔动脉外径为3.2mm,变异闭孔静脉为6.3mm,与耻骨联合的距离分别为45mm,48mm。1.2闭孔神经血管束静息下,闭孔神经与骨盆缘距离14.6±2.4mm,闭孔动脉与骨盆缘距离19.3±1.5mm,闭孔静脉与骨盆缘距离25.6± 1.7mm。在坐骨小切迹位置牵拉下,闭孔神经与骨盆缘的距离19.5±1.8mm,闭孔动脉与骨盆缘距离30.1 ±2.6mm,闭孔静脉与骨盆缘距离39.2 ±3.8mm。1.3臀上神经血管束臀上神经血管束位于坐骨大切迹顶点后方,7例标本从前向后的解剖顺序是臀上神经、臀上动脉、臀上静脉,1例标本左侧臀上动脉位于最前方。臀上神经血管束与坐骨大切迹顶点距离8.6 ±2.2mm,臀上动脉外径4.3 ±0.6mm。1.4坐骨神经坐骨神经上缘投影点到坐骨大切迹顶点距离15.4±2.5mm,坐骨神经下缘投影点与坐骨棘上5.6±3.5mm,坐骨神经中点到坐骨大切迹后缘约为3.4±1.2mm。1.5阴部内动脉和阴部神经阴部内动脉与坐骨大切迹距离3.6±1.5mm,血管外径2.3±0.8mm。阴部神经位于阴部内动脉内侧或内下方。2.改良Stoppa入路和髂腹股沟入路临床治疗效果比较1、根据搜索关键词((Stoppa Approach)OR(AnteriorApproach))AND(Acetabular Fracture),得到初始搜索结果204个,根据纳入标准,排除不符合结果,最终得到共10篇英文文献,其中4篇是Stoppa入路与髂腹股沟入路临床治疗病例的比较性分析。结论1、闭孔神经血管束在坐骨小切迹位置可被牵拉,提供手术操作空间,但需注意牵拉张力。2、坐骨大切迹顶点与后方臀上神经血管束以及下方坐骨神经近存在安全区域,可以作为显露或复位支点。3、坐骨大切迹后缘与坐骨神经存在一定距离,在该位置放置复位器时仍需减少后方移动,髋关节呈伸直或过伸位可减少坐骨神经张力。4、坐骨棘水平后方的阴部内动脉与坐骨大切迹极为接近,需要小心保护。5、改良Stoppa入路在四边体和髋臼后柱更宽阔的视野,可更合理的放置钢板,治疗涉及双柱骨折可能治疗效果更好。解剖结构简单易于掌握。但对于已经熟练掌握髂腹股沟入路的骨科医生,使用两种入路的治疗效果无明显差别。
[Abstract]:Objective First, to record and measure the relationship between the posterior anatomical structure of the greater pelvic ischial notch and the posterior of the greater ischial notch through the anatomical study of pelvic specimens. Pelvic specimens were provided by the Department of Anatomy, Southern Medical University. Eight pelvic specimens, six males and two females, were obtained. 2. The improved Stoppa approach was used to expose the tetrahedron, posterior column wall, and large ischial notch. The inclusion criteria were: (Stoppa Approach OR "Anterior Approach") and "Acetabular fracture" 2. Patients were generally older than 15 years and younger than 65 years, excluding the treatment of acetabular fractures in children and the elderly; 2. Literatures were case reports. Analysis of data, comparative indicators need to be related to operation time and bleeding volume, fracture reduction rate, complications, etc. 3. Exclude pelvic fractures, rectus abdominis accessory approach and specific fracture treatment cases; 4. Treatment methods include modified Stoppa approach or modified Stoppa approach and ilioinguinal approach treatment case analysis; 5. English literature; 6. 2010 onwards; 6. Results 1. Single dead coronary artery was found in 6 cases of 1.1 deaths by modified Soppa approach, all of which were venous and originated from the inferior epigastric vein. No dead coronary artery or obturator vessel was found on both sides of the abdomen. The diameter of the obturator artery was 3.2 mm, the variator obturator vein was 6.3 mm, and the distance from the pubic symphysis was 45 mm, 48 mm.1.2, respectively. The distance between the obturator artery and the pelvic margin was 19.3 + 1.5 mm, the distance between the obturator vein and the pelvic margin was 25.6 + 1.7 mm, the distance between the obturator nerve and the pelvic margin was 19.5 + 1.8 mm, the distance between the obturator artery and the pelvic margin was 30.1 + 2.6 mm, the distance between the obturator vein and the pelvic margin was 39.2 + 3.8 mm, and the distance between the obturator vein and the pelvic margin was 39.2 + 3.8 mm The superior gluteal nerve vascular bundle was located at the rear of the apex of the great sciatic notch. The anatomical order of 7 cases was superior gluteal nerve, superior gluteal artery and superior gluteal vein. The left superior gluteal artery was located at the front of the great sciatic notch. The distance between the superior gluteal nerve vascular bundle and the apex of the great sciatic notch was 8.6 (?) 2.2 mm, and the external diameter of the superior gluteal artery was 4.3 (?) 0.6 mm.1. The distance from the projection point of the superior margin to the apex of the great sciatic notch was 15.4 (+ 2.5mm), from the projection point of the inferior margin of the sciatic nerve to the superior sciatic spine was 5.6 (+ 3.5mm), from the middle point of the sciatic nerve to the posterior margin of the great sciatic notch was 3.4 (+ 1.2mm). Comparisons of clinical outcomes between modified Stoppa approach and ilioinguinal approach 1. According to search keywords (Stoppa Approach OR (Anterior Approach)) and (Acetabular Fracture), 204 initial search results were obtained. According to inclusion criteria, a total of 10 English literatures were obtained, 4 of which were S. Conclusion 1. Obturator nerve and blood vessel bundles can be pulled at the position of small sciatic notch to provide operation space, but attention should be paid to the tension. 2. There is a safe area near the apex of the great sciatic notch to the posterior superior gluteal nerve and blood vessel bundles and the inferior sciatic nerve. 3. There is a certain distance between the posterior margin of the great sciatic notch and the sciatic nerve. The posterior movement of the sciatic nerve should be reduced when the sciatic nerve is placed in this position. The tension of the sciatic nerve can be reduced by extending or overextending the hip. 4. The internal pudendal artery behind the level of the sciatic spine is very close to the great sciatic notch. 5. Modified Stoppa insertion is needed. The anatomy is simple and easy to grasp, but there is no significant difference between the two approaches for orthopedists who have mastered the ilioinguinal approach.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3;R322
本文编号：2229011
[Abstract]:Objective First, to record and measure the relationship between the posterior anatomical structure of the greater pelvic ischial notch and the posterior of the greater ischial notch through the anatomical study of pelvic specimens. Pelvic specimens were provided by the Department of Anatomy, Southern Medical University. Eight pelvic specimens, six males and two females, were obtained. 2. The improved Stoppa approach was used to expose the tetrahedron, posterior column wall, and large ischial notch. The inclusion criteria were: (Stoppa Approach OR "Anterior Approach") and "Acetabular fracture" 2. Patients were generally older than 15 years and younger than 65 years, excluding the treatment of acetabular fractures in children and the elderly; 2. Literatures were case reports. Analysis of data, comparative indicators need to be related to operation time and bleeding volume, fracture reduction rate, complications, etc. 3. Exclude pelvic fractures, rectus abdominis accessory approach and specific fracture treatment cases; 4. Treatment methods include modified Stoppa approach or modified Stoppa approach and ilioinguinal approach treatment case analysis; 5. English literature; 6. 2010 onwards; 6. Results 1. Single dead coronary artery was found in 6 cases of 1.1 deaths by modified Soppa approach, all of which were venous and originated from the inferior epigastric vein. No dead coronary artery or obturator vessel was found on both sides of the abdomen. The diameter of the obturator artery was 3.2 mm, the variator obturator vein was 6.3 mm, and the distance from the pubic symphysis was 45 mm, 48 mm.1.2, respectively. The distance between the obturator artery and the pelvic margin was 19.3 + 1.5 mm, the distance between the obturator vein and the pelvic margin was 25.6 + 1.7 mm, the distance between the obturator nerve and the pelvic margin was 19.5 + 1.8 mm, the distance between the obturator artery and the pelvic margin was 30.1 + 2.6 mm, the distance between the obturator vein and the pelvic margin was 39.2 + 3.8 mm, and the distance between the obturator vein and the pelvic margin was 39.2 + 3.8 mm The superior gluteal nerve vascular bundle was located at the rear of the apex of the great sciatic notch. The anatomical order of 7 cases was superior gluteal nerve, superior gluteal artery and superior gluteal vein. The left superior gluteal artery was located at the front of the great sciatic notch. The distance between the superior gluteal nerve vascular bundle and the apex of the great sciatic notch was 8.6 (?) 2.2 mm, and the external diameter of the superior gluteal artery was 4.3 (?) 0.6 mm.1. The distance from the projection point of the superior margin to the apex of the great sciatic notch was 15.4 (+ 2.5mm), from the projection point of the inferior margin of the sciatic nerve to the superior sciatic spine was 5.6 (+ 3.5mm), from the middle point of the sciatic nerve to the posterior margin of the great sciatic notch was 3.4 (+ 1.2mm). Comparisons of clinical outcomes between modified Stoppa approach and ilioinguinal approach 1. According to search keywords (Stoppa Approach OR (Anterior Approach)) and (Acetabular Fracture), 204 initial search results were obtained. According to inclusion criteria, a total of 10 English literatures were obtained, 4 of which were S. Conclusion 1. Obturator nerve and blood vessel bundles can be pulled at the position of small sciatic notch to provide operation space, but attention should be paid to the tension. 2. There is a safe area near the apex of the great sciatic notch to the posterior superior gluteal nerve and blood vessel bundles and the inferior sciatic nerve. 3. There is a certain distance between the posterior margin of the great sciatic notch and the sciatic nerve. The posterior movement of the sciatic nerve should be reduced when the sciatic nerve is placed in this position. The tension of the sciatic nerve can be reduced by extending or overextending the hip. 4. The internal pudendal artery behind the level of the sciatic spine is very close to the great sciatic notch. 5. Modified Stoppa insertion is needed. The anatomy is simple and easy to grasp, but there is no significant difference between the two approaches for orthopedists who have mastered the ilioinguinal approach.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3;R322
【参考文献】
相关期刊论文 前1条
1 蒋电明 ,余学东 ,安洪 ,梁勇 ,梁安霖;Hip and pelvic fractures and sciatic nerve injury[J];Chinese Journal of Traumatology;2002年06期
，本文编号：2229011
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