髂骨螺钉骨性通道毗连血管及神经的解剖学研究

Applied anatomy for transiliac screws: adjacent vessels and nerves in the pelvis

目的探讨经髂后上棘到髂前下棘髂骨螺钉通道附近的血管、神经分布,为临床手术提供参考。方法采用12具防腐骨盆标本,模拟手术操作,从后向前沿骨盆经髂后上棘到髂前下棘骨性通道钻入3.5 mm钢针,观察盆腔内重要的血管神经和钢针空间关系,找出在放置髂骨螺钉时血管神经易损伤区域。结果髂骨翼后部,血管、神经与髂骨之间有腰大肌相隔开,进行放置螺钉操作中不易损伤;骨盆壁侧方,闭孔血管和闭孔神经距离盆壁都很近,在进行内固定操作时,如果导针或螺钉进钉角度偏小,对这些结构就有可能造成医源性损伤;髋臼及腹股沟区,因髂前下棘与旋髂深动脉距离最近,所以此动脉损伤几率最大。结论由后向前植入髂骨螺钉时,髂骨翼后部较为安全,但骨盆壁侧方和髋臼及腹股沟区较危险,闭孔血管、神经和旋髂深动脉容易受到损伤。

Objective To observe the location of the pelvic vessels and nerves on the pelvic sides,measure the vertical distance from vessels and nerves to pelvic sides to give a light on the surgical procedures. Methods In accordance with the rules and regulations of the university, we used 12 embalmed cadaveric pelvises（6 male, 6 female） without any gross structural abnormalities to guarantee the conformity among anatomic measurement. All specimens underwent simulated surgery in the ventral decubitus. K-wire was drilled from the posterior superior iliac spine to the anterior inferior iliac spine and the spatial relation can be observed between the wire and the vessels and nerves. At last, the dangerous region on the pelvic wall can be located while the wire was drilled. Results The dangerous region was located on the lateral wall of pelvic and inguinal region. The K-wire may stick into acetabulum if the drilling angle is smaller. On the other hand, the obturator artery, obturator nerve and deep iliac circumflex artery will be injured while the drilling angle was larger or the screw is longer. Conclusions The screw can be implanted safely from posterior superior iliac spine to anterior inferior iliac spine with a suitable drilling angel and length. Importantly, the dangerous region is located on the lateral wall of pelvic and inguinal region.