经皮逆行耻骨上支通道螺钉入针点与重要生殖结构解剖学距离的观测

The distance between the insertion point of the percutaneous retrograde superior pubic ramus screw and the critical reproductive structures:an anatomical study

目的 测量经皮逆行耻骨上支通道螺钉导针入针点与周围重要生殖结构的解剖学距离,为临床置钉提供精准的解剖学数据,降低术中损伤重要生殖结构的风险。方法 选取14例防腐成年尸体标本,C臂机监视下,徒手自理想入针点完成经皮逆行耻骨上支通道螺钉导针置入,对标本进行解剖,测量男性标本中导针入针点到精索、阴茎背神经、海绵体的最近距离,测量女性标本中导针入针点到子宫圆韧带、阴蒂背神经、阴蒂体基底部、阴蒂头的最近距离。结果 男、女性左、右两侧导针入针点与各重要生殖结构距离的数值差异均无统计学意义(P>0.05)。男性标本导针入针点与同侧精索的平均距离(49.70±6.04)mm>对侧精索(20.57±9.59)mm>阴茎背神经(19.79±5.36)mm>海绵体(17.56±5.95)mm;女性标本导针入针点与同侧子宫圆韧带的平均距离(63.20±9.67)mm>对侧子宫圆韧带(55.25±6.52)mm>阴蒂头(39.82±3.03)mm>阴蒂背神经(23.80±6.04)mm>阴蒂体基底部(17.96±2.93)mm。入针点距对侧精索与对侧子宫圆韧带两者、入针点距同侧精索与同侧子宫圆韧带两者,差异有统计学意义(P<0.01),入针点距阴茎背神经与阴蒂背神经两者、入针点距海绵体与阴蒂体基底部两者,差异无统计学意义(P>0.05)。结论 经皮逆行耻骨上支螺钉置入过程存在损伤周围生殖结构的风险,使用软组织保护套筒和避免多次经皮插入导针可减少损伤这些结构的风险。

Objective To measure the anatomical distance between the percutaneous insertion point of the guide wire of the retrograde superior ramus pubis cannulated screw,which provides accurate anatomical data for placement of the retrograde superior pubic ramus screws in the treatment of superior pubic ramus or anterior column fractures of acetabula.According to the anatomical data,the risk of intraoperative injury about critical reproductive structures may be avoided.Methods All 14 embalmed adult cadavers(9 male and 5 female)were selected.Under the fluoroscopy of C-arm,the percutaneous retrograde insertion of guide wire in superior pubic ramus was completed by the first autor with hand from the ideal insertion point,and pelvic inlet,outlet and obturator outlet views confirmed that all the guide needles were located in the osseous channel of superior ramus of the pubis.The specimens were dissected and the closest distance from the skin entry point of guide wire to the spermatic cord,the dorsal nerve of the penis,the root of the penis and the cavernous body was measured in the male specimen.In female specimens,the closest distance from the needle point to the round ligament of the uterus,dorsal clitoral nerve,base of clitoral body and clitoris glans was measured.Results There was no statistical significance in the distance between the insertion points on the left and right sides of the guide wire and the critical reproductive structures in male and female(P>0.05).The mean distance between the insertion point and ipsilateral spermatic cord in male specimens was(49.70±6.04)mm>the contralateral spermatic cord(20.57±9.59)mm>dorsal penile nerve(19.79±5.36)mm>cavemosum(17.56±5.95)mm.The mean distance between the insertion point of the guide needle and the ipthalateral round ligament in female specimens was(63.20±9.67)mm>the contralateral round ligament(55.25±6.52)mm>the clitoral head(39.82±3.03)mm>the dorsal clitoral nerve(23.80±6.04)mm>the base of the clitoral body(17.96±2.93)mm.There was statistically significant difference between the insertion point of the contralateral spermatic cord and the contralateral round ligament of the uterus,and between the insertion point of the contralateral spermatic cord and the ipsilateral round ligament of the uterus(PvO.Ol).There was no statistically significant difference between the insertion point and the dorsal nerve of the penis and the dorsal clitoral nerve,and between the insertion point and the cavernous body and the base of the clitoris(P〉0.05).Conclusion There is a risk of injury to those important reproductive structures during placement of percutaneous retrograde superior pubic ramus screw,using soft tissue sleeve and avoidance of multiple attempts of guidewire insertion may reduce the risk of injury to these important reproductive structures.