中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2014年
1期
15-19
,共5页
禹宝庆%周海燕%张传森%黄会龙%黄淦
禹寶慶%週海燕%張傳森%黃會龍%黃淦
우보경%주해연%장전삼%황회룡%황감
骨盆%髋臼%解剖学%骨盆前侧入路
骨盆%髖臼%解剖學%骨盆前側入路
골분%관구%해부학%골분전측입로
Pelvis%Acetabulum%Anatomy%Anterior a pelvic surgical approach
目的 对骨盆前侧手术入路治疗骨盆髋臼骨折进行解剖学研究,以证实该入路的可行性. 方法 成人尸体标本10例20侧,进行大体层次解剖,观察下腹部腹壁及盆腔内解剖结构位置及变异情况.在解剖学研究的基础上,临床应用20例骨盆骨折及15例髋臼骨折,观察骨盆前侧入路的临床效果. 结果 骨盆前侧入路的切口全长均不分离暴露精索/子宫圆韧带.腹壁肌层纵形分离切口位于腹直肌外侧和腹壁下动静脉起始循行部位的内侧.采用该入路临床应用35例,平均切口长度10 cm(9～12 cm),失血量(225.5 ±30.5)ml(170 ～350 ml),所有患者未见股神经和坐骨神经损伤,术后均未出现深静脉血栓形成,切口均Ⅰ期愈合.所有患者术后获平均18个月(11 ～35个月)随访,均获骨性愈合. 结论 骨盆前侧手术入路将术野自耻骨联合一直延续至骶髂关节前外侧以及四边区,实现对骨折部位的充分显露.该入路治疗骨盆髋臼骨折具有安全性高、损伤小、术野暴露充分、临床效果良好等优点,有一定的临床推广价值.
目的 對骨盆前側手術入路治療骨盆髖臼骨摺進行解剖學研究,以證實該入路的可行性. 方法 成人尸體標本10例20側,進行大體層次解剖,觀察下腹部腹壁及盆腔內解剖結構位置及變異情況.在解剖學研究的基礎上,臨床應用20例骨盆骨摺及15例髖臼骨摺,觀察骨盆前側入路的臨床效果. 結果 骨盆前側入路的切口全長均不分離暴露精索/子宮圓韌帶.腹壁肌層縱形分離切口位于腹直肌外側和腹壁下動靜脈起始循行部位的內側.採用該入路臨床應用35例,平均切口長度10 cm(9～12 cm),失血量(225.5 ±30.5)ml(170 ～350 ml),所有患者未見股神經和坐骨神經損傷,術後均未齣現深靜脈血栓形成,切口均Ⅰ期愈閤.所有患者術後穫平均18箇月(11 ～35箇月)隨訪,均穫骨性愈閤. 結論 骨盆前側手術入路將術野自恥骨聯閤一直延續至骶髂關節前外側以及四邊區,實現對骨摺部位的充分顯露.該入路治療骨盆髖臼骨摺具有安全性高、損傷小、術野暴露充分、臨床效果良好等優點,有一定的臨床推廣價值.
목적 대골분전측수술입로치료골분관구골절진행해부학연구,이증실해입로적가행성. 방법 성인시체표본10례20측,진행대체층차해부,관찰하복부복벽급분강내해부결구위치급변이정황.재해부학연구적기출상,림상응용20례골분골절급15례관구골절,관찰골분전측입로적림상효과. 결과 골분전측입로적절구전장균불분리폭로정색/자궁원인대.복벽기층종형분리절구위우복직기외측화복벽하동정맥기시순행부위적내측.채용해입로림상응용35례,평균절구장도10 cm(9～12 cm),실혈량(225.5 ±30.5)ml(170 ～350 ml),소유환자미견고신경화좌골신경손상,술후균미출현심정맥혈전형성,절구균Ⅰ기유합.소유환자술후획평균18개월(11 ～35개월)수방,균획골성유합. 결론 골분전측수술입로장술야자치골연합일직연속지저가관절전외측이급사변구,실현대골절부위적충분현로.해입로치료골분관구골절구유안전성고、손상소、술야폭로충분、림상효과량호등우점,유일정적림상추엄개치.
Objective To perform an anatomical study on anterior approach to fractures of the pelvis and acetabulum in an attempt to testify feasibility of the approach.Methods Position and variation of anatomical structure of the hypogastric abdominal wall and pelvic cavity were observed in 10 cadaveric adults (20 sides).Based on the anatomical study,anterior approach to pelvic fractures (n =20)and acetabular fractures (n =15) were performed and clinical results were observed.Results Anterior pelvic incision revealed no splitting or exposure of the spermatic cord/round ligament of uterus.Vertical incision through the muscle layer of abdominal wall located at lateral rectus abdominis and medial initial segment of hypogastric arteries/veins.In clinical practice,the approach revealed the mean incision length of 10 cm (range,9-12 cm) and mean blood loss of (225.5 ± 30.5) ml (range,170-350 ml).No injuries to femoral nerve and sciatic nerve occurred and there was no deep vein thrombosis.Surgical incision healed primarily.Bone union were recorded at the 18-month follow-up (11-35 months).Conclusions Anterior pelvic approach stretches the operative field from pubic symphysis to anterior-lateral cacroiliac joint and quadrilateral surface,allowing full exposure of the fracture site.The approach has benefits of high safety,minor trauma,large exposure,and satisfactory results and hence deserves wide application in clinical settings.
