改良Stoppa入路死亡冠血管的解剖学研究

Anatomic study of corona mortis in modified Stoppa approach

目的研究改良Stoppa入路髂外和腹壁下血管与闭孔血管在耻骨上支区的吻合支（死亡冠）解剖学特点，为提高骨盆髋臼前路手术操作安全性提供解剖学基础。方法模拟改良Stoppa入路对12具国人成人尸体标本共24侧半骨盆进行解剖学研究。观测死亡冠血管的出现率、直径大小、长度及其至耻骨联合和髂耻隆起的距离。结果87．5％（21侧）耻骨上支表面存在死亡冠血管，其中62．5％（15侧）为静脉型，8．3％（2侧）为动脉型，16．7％（4侧）为混合动静脉型。死亡冠血管的长度平均32．1（24．1～40．6）mm，直径平均2．5（2．0～3．7）mm。死亡冠血管至耻骨联合距离平均54．9（47．8～63．8）mm，至髂耻隆起距离平均20.3（6．2～35．0）mm。死亡冠血管紧贴耻骨上支，移动度小。结论死亡冠血管出现率高，变异度大，以静脉型为主。移位骨盆前环髋臼骨折及前入路手术时易损伤死亡冠血管，应注意其存在并妥善处理，推荐骨膜下剥离。

Objective To provide anatomic basis for safely performing anterior approaches to the pelvis and acetabulum, by carrying out an anatomical study of corona morris （CMOR） vessels which are the anastomotic vessels between the ohturator vessels and the external iliae vessels or inferior epigastric vessels located at superior pubic ramus region. Methods Twelve pelvis specimens of Chinese adult cadavers with intact soft tissues （24 hemi-pelvises） were dissected via the modified Stoppa approach to observe CMOR vessels in the study. The length, the diameter, the distance between the anastomotic vessels and the symphysis pubis or the ilio-pectineal elevation were measured. The incidence of the CMOR vessels were studied. Results Among the 24 lateral hemi-pelvises there were 21 lateral hemi-pelvises with the CMOR vessels（8.3% arterial; 62.5% venous; 16.7% combined）, the rate of oceurance was 87.5%. The average diameter of the CMOR vessels was 2.5 mm （2.0-3.7 mm）. The average length of CMOR vessels between the obturator vessels and the external iliac vessels or inferior epigastric vessels was 32.1 mm（24.1-40.6 mm）. The distance from the CMOR vessels to the symphysis averaged 54.9 mm（47.8-63.8mm）, and to the ilio-pectineai elevation averaged 20.3 mm（6.2-35.0 mm）. The CMOR vessels were just over the superior pubic ramus with only little movement. Conclusion The CMOR vessel has a high incidence, and more variability, the common type is venous branch. It is easily damaged in displaced fractures of the acetabulum and anterior pelvic ring, or in anterior approach to the acetabulum and pelvis. The attention should be paid to the existence of the CMOR vessels under these conditions. Stripping under the periosteum is recommended.