逆行耻骨上支通道螺钉两种入针点与生殖结构距离的解剖研究

Anatomic study on the distance between two insertion points and reproductive structures of retrograde superior ramus intramedullary screw

目的测量两种不同经皮逆行耻骨上支螺钉导针入针点与周围重要生殖结构的解剖距离,比较两种入针点的导针置入时损伤周围重要生殖结构的风险,为临床安全置钉提供依据。方法选取14例防腐成年大体标本,C臂机监视下,徒手完成双侧经皮逆行螺钉导针置入,一侧A入针点选择于耻骨体内缘皮质的前端点,对侧B入针点选择于耻骨体腹侧皮质耻骨结节内侧点,影像设备监视下证实所有导针均位于骨性通道内。解剖标本,显露重要生殖结构,测量男性标本中两入针点到双侧精索、阴茎背神经、阴茎海绵体的最近距离,女性标本中测量两入针点到子宫圆韧带、阴蒂背神经、阴蒂体底部、阴蒂龟头的最近距离。结果A入针点,与同侧精索的平均距离(51.17±5.82)mm>阴茎背神经(20.94±4.16)mm>对侧精索(19.77±5.23)mm>阴茎海绵体(19.65±7.30)mm,与同侧子宫圆韧带的平均距离(63.12±10.26)mm>对侧子宫圆韧带(56.11±8.20)mm>阴蒂头(40.72±3.30)mm>阴蒂背神经(20.46±5.81)mm>阴蒂体基底部(17.72±1.76)mm;B入针点,与对侧精索(32.22±8.50)mm>阴茎背神经(31.18±6.23)mm>同侧精索的平均距离(27.09±5.58)mm>阴茎海绵体(20.01±7.54)mm;与阴蒂头(52.80±5.91)mm>阴蒂背神经(50.79±5.05)mm>对侧子宫圆韧带(43.40±6.70)mm>同侧子宫圆韧带的平均距离(35.04±11.25)mm>阴蒂体基底部(33.99±3.86)mm。结论A入针点损伤男性对侧精索、阴茎背神经及女性阴蒂背神经、阴蒂体底部的风险大于B入针点;B入针点损伤阴蒂背神经的可能性大于阴蒂背神经,损伤阴茎背神经损伤阴蒂体基底部的可能性大于阴茎海绵体,同种入针点行相同操作时需注意。

Objective To measure the anatomical distance between the insertion point of two different percutaneous retrograde superior ramus of the pubis screw and the surrounding important reproductive structure,and compare the risk of damaging the surrounding important reproductive structure during the insertion of the two insertion points,so as to provide basis for clinical safety of the insertion of the screw.Methods Fourteen anticorrosive adult specimens were selected.With the C arm machine monitoring,bilateral percutaneous retrograde screw needle placement was completed by hand.The entry point of A was selected at the front end of the cortex of the internal margin of the pubis,and the entry point of B was selected at the medial point of the pubic tuberculum in the ventral cortex of the pubis.Imaging monitoring equipment confirmed that all needles were located in the osseous channel.Anatomical specimens were used to expose important reproductive structures.The closest distance between the two insertion points and bilateral spermatic cord,dorsal nerve of penis,and corpus cavernosum of the penis was measured in male specimens.The closest distance between the two insertion points and round uterine ligament,the dorsal nerve of the clitoris,the base of the clitoral body,and the glans of the clitoris was measured in female specimens.Results The average distance between the insertion point A and ipsilateral spermatic cord was(51.17±5.82)mm>the dorsal nerve of penis(20.94±4.16)mm>the contralateral spermatic cord(19.77±5.23)mm>the corpus cavernosum(19.65±7.30)mm.The average distance between the entry point A and the ipsilateral round uterine ligament was(63.12±10.26)mm>the contralateral round uterine ligament(56.11±8.20)mm>the glans of clitoris(40.72±3.30)mm>the dorsal nerve of clitoris(20.46±5.81)mm>the base of clitoral body(17.72±1.76)mm.The mean distance between the insertion point B and the contralateral spermatic cord was(32.22±8.50)mm>the dorsal nerve of penis(31.18±6.23)mm>the ipsilateral spermatic cord(27.09±5.58)mm>penile cavernous body(20.01±7.54)mm.The mean distance between the insertion point B and the clitoral head was(52.80±5.91)mm>the dorsal nerve of clitoris(50.79±5.05)mm>the contralateral round ligament(43.40±6.70)mm>the ipsilateral round ligament(35.04±11.25)mm>the base of the clitoral body(33.99±3.86)mm.Conclusions The risk of injury of the contralateral spermatic cord,the dorsal nerve of penis,in male and the dorsal nerve of clitoris,the base of the clitoral body in female at the insertion point A is higher than that at the insertion point B.For the insertion point B,the possibility of injury to the dorsal nerve of clitoris in male is greater than that of in female,the possibility of injury to the dorsal penile nerve and the base of the clitoral body is greater than that of than the cavernosum of the penis.Caution should be paid when performing the same operation at the same insertion point.