女性骨盆内前入路潜在危险的形态学测量:一项尸体研究。

IF 1.1 4区 医学 Q3 ORTHOPEDICS Acta orthopaedica et traumatologica turcica Pub Date : 2023-07-01 DOI:10.5152/j.aott.2023.23013
Ahmet Özmeriç, Kadir Bahadır Alemdaroğlu, Ayşegül Fırat, Özgür Şahin
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引用次数: 1

摘要

目的:本研究旨在通过提供女性髋臼骨折骨盆内前入路固定过程中由于骨标志不变而导致的一些最脆弱的动脉和神经的详细形态测量数据,提高骨盆/髋臼创伤外科医生的外科解剖知识。方法:从5具女性尸体上解剖10具半骨盆。进行了以下关于联合的测量:(1)冠骨吻合的距离和(2)髂外静脉与耻骨支的平分线。此外,还测量了以下结构在果胶凸度水平上到骨盆边缘的距离:(3)闭孔神经血管束的深度,(4)膀胱上动脉和(5)阴道动脉。此外,由于仰卧位的坐骨切口,(6)臀上下血管的时钟位置。由于骶髂关节前上角(7)髂总动脉分叉的位置,(8)髂内血管至干的分叉位置,(9)臀上动脉和骶外侧动脉的分叉,以及(10)L5神经。描述性统计数据以中位数和范围给出,因为这是一项没有比较的描述性解剖学研究。结果:颈冠至耻骨联合的中位距离为59.5mm(范围=58-61)。髂外静脉将耻骨联合外侧68.5 mm(范围=65-70)的耻骨臂一分为二。在果胶凸度水平(约骨盆边缘的中部),闭孔神经血管束、膀胱上动脉和阴道动脉分别比骨盆边缘低15mm(范围=13-16)、24mm(范围=23-25)和36mm(范围=34-38)。臀上血管在仰卧位12点钟位置离开坐骨切迹。臀下血管在31/2点钟位置离开坐骨切口(左侧)。髂总动脉分叉将骶髂关节前上角上方5 mm(4-7)的骶髂关节一分为二。髂内动脉使其后干在SI关节前上角正前方18mm(范围=115-20)。臀上动脉和骶外侧动脉的分叉距离后干的起点11mm(范围=10-12)。L5根的内侧边缘在该标志的内侧9mm(范围=7-10),其外侧缘在SI关节上(内侧2mm至外侧2mm)来自这项研究。证据级别:不适用。
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Morphometric measurements for potential dangers of anterior intra-pelvic approach in women: A cadaveric study.

Objective: This study aimed to improve the surgical anatomical knowledge of pelvic/acetabular trauma surgeons by providing detailed morphometric data on some of the most vulnerable arteries and nerves due to constant bony landmarks during anterior intra-pelvic approach fixation of acetabular fractures in women.

Methods: Ten hemipelvis were dissected from 5 female cadavers. The following measurements relative to the symphysis were performed: (1) the distance of the corona mortis anastomosis and (2) the bisection of the external iliac vein with the pubic ramus. In addition, dis- tance to the pelvic brim at the level of pectineal convexity of the following structures was measured: (3) depth of obturatory neurovascu- lar bundle, (4) superior vesical artery, and (5) vaginal artery. Also, the clock position of the (6) gluteal superior and inferior vessels due to sciatic notch in the supine position. Due to antero-superior corner of sacroiliac joint (7) location of the common iliac artery bifurcation, (8) location of the bifurcation of internal iliac vessels to truncuses, (9) bifurcation of superior gluteal artery and lateral sacral artery, and (10) L5 nerve were measured. The descriptive statistics were given as medians and ranges as this is a descriptive anatomical study without comparisons.

Results: The median distance of corona mortis to symphysis pubis was 59.5 mm (range = 58-61). The external iliac vein bisected the pubic arm 68.5 mm (range=65-70) lateral to the symphysis pubis. At the level of pectineal convexity (about the middle of the pelvic brim), obturatory neurovascular bundle, superior vesical artery, and vaginal artery were 15 mm (range=13-16), 24 mm (range=23-25), and 36 mm (range=34-38) inferior to the pelvic brim, respectively. The superior gluteal vessels leave the sciatic notch at 12 o'clock position in supine position. Inferior gluteal vessels leave the sciatic notch at 31⁄2 o'clock position (given for left side). Common iliac artery bifurcation bisects the SI joint 5 mm (4-7) superior to antero-superior corner of the Sacro-iliac (SI) joint. The internal iliac artery gives its posterior trunk 18 mm (range=15-20) straightly anterior to antero-superior corner of the SI joint. Bifurcation of superior gluteal artery and lateral sacral artery was 11 mm (range = 10-12) away from the beginning of the posterior truncus. L5 root's medial margin was 9 mm (range = 7-10) medial to this landmark, where its lateral margin was on the SI joint (2 mm medial to 2 mm lateral).

Conclusion: The majority of the bleeding complications of the major branches of the internal and external iliac arteries and neurologic palsies due to obturatory nerve and L5 nerve root damage within the operative field of the anterior intra-pelvic approach can be avoided or managed by utilizing morphometric data provided from this study.

Level of evidence: N/A.

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来源期刊
CiteScore
2.00
自引率
0.00%
发文量
66
审稿时长
>12 weeks
期刊介绍: Acta Orthopaedica et Traumatologica Turcica (AOTT) is an international, scientific, open access periodical published in accordance with independent, unbiased, and double-blinded peer-review principles. The journal is the official publication of the Turkish Association of Orthopaedics and Traumatology, and Turkish Society of Orthopaedics and Traumatology. It is published bimonthly in January, March, May, July, September, and November. The publication language of the journal is English. The aim of the journal is to publish original studies of the highest scientific and clinical value in orthopedics, traumatology, and related disciplines. The scope of the journal includes but not limited to diagnostic, treatment, and prevention methods related to orthopedics and traumatology. Acta Orthopaedica et Traumatologica Turcica publishes clinical and basic research articles, case reports, personal clinical and technical notes, systematic reviews and meta-analyses and letters to the Editor. Proceedings of scientific meetings are also considered for publication. The target audience of the journal includes healthcare professionals, physicians, and researchers who are interested or working in orthopedics and traumatology field, and related disciplines.
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