髋臼上方置钉骨盆外固定的应用解剖

Clinic anatomy of supraacetabular external fixation for pelvic fracture

目的：为髋臼上方置钉进行骨盆外固定手术提供应用解剖学参考资料。方法：对20例40侧尸体骨盆的髂前下棘区域进行观察测量，获取髂前下棘与股动脉、股神经、股外侧皮神经、旋髂深动脉等毗邻血管神经的距离。对髋臼上置钉的钉道进行测量．获取钉道的长度、宽度。钉道与髋臼边缘及坐骨大切迹的距离等。所得数据按性别分组进行统计学处理。结果：髂前下棘为股直肌起始部，表面为髂肌覆盖，缝匠肌由外上至内下斜行越过髂前下棘外下方。男性股动脉位于髂前下棘内侧（27．54±3．53）mm，女性为（27．15±0．81）mm；男性股神经位于髂前下棘内侧（17．61±3．47）mm，女性为（19．26±4．21）mm。男性股外侧皮神经位于髂前下棘外侧（23．24±5．33）mm，女性为（17．82±3．26）mm；男性旋髂深动脉位于髂前下棘上方（16．26±1．77）mm，女性为（14．06±2．16）mm。男性髋臼上钉道长度为（147．76±7．39）mm，女性为（142．75±6．36）mm；男性钉道位于髋臼上方（25．10±4．43）mm，女性为（19．35±3．54）mm；男性钉道位于坐骨大切迹上方（25．01±3．61）mm，女性为（21．34±3．17）mm。结论：髋臼上方置钉骨盆外固定手术，应选取在腹股沟韧带外侧1／14下方约1cm处作一平行切口，采用纵形钝性劈开髂肌的方式，以套筒保护下在髂前下棘处置入固定钉，避免损伤周围组织。由髂前下棘到髂后上棘间的钉道为一完整连续的骨性钉道，可为骨盆外固定提供足够的钉道长度和同定强度。

Objective： To provide anatomical data for the supraacetabular external fixation of pelvic fracture. Methods： The anatomic data of the anterior inferior iliac spine from 40 sides in 20 intact cadaver were measured including the distances from the anterior inferior iliac spine to the femoral artery, femoral nerve, lateral femoral cutaneous nerve, deep iliac circulflex artery. Then the pin tract of supraacetabular external fixation was dissected. The length and width of the pin tract, and the distances to the acetabular rim and greater sciatic notch was measured. The data were analyzed by SPSS 13. 0. Results： The anterior inferior iliac spine provided the origin of rectus femoris, which was covered by iliacus; and sartorius was across the anterior inferior iliac spine superotalerally to inferomedially. In male, the distances from the anterior inferior iliac spine to the femoral artery, femoral nerve, lateral femoral cutaneous nerve, deep lilac circulflex artery were 27. 5±3. 53 mm, 17. 61 ±3.47 mm, 23.24±5.33 mm, 16.26±1.77 mm; versus in female were 27.15±0.81 mm, 19.26±4. 21 mm, 17. 82±3.26 mm, 14.06±2. 16 mm. In male the length of the pin tract was 147.76±7.39 mm, versus in female was 142.75±6.36 mm. The distance form the pin tract to acetahular rim and greater sciatic notch was 25, 10±4.43 mm and 25.01±3.61 mm, versus in female was 19.35±3.54 mm and 21.34±3. 17 mm. Conclusion： In the operation of pelvic fracture,where supraac- etabular external fixation is used, the incision should be paraller inguinal ligament, and the center is down the outer 1/4 of inguinal ligament.The iliacus muscle is split and sleeve setting is used to preserve the soft tissue. The pin tract from the anterior inferior iliac spine to the posterior superior iliac spine was intact and continuous, which proved sufficient pin tract length and intensity for pelvic external fixation.