骶前静脉的解剖及在骨盆骨折大出血中的临床意义

Anatomy of the anterior sacral veins and its clinical significance in hemorrhage in pelvic fractures

目的探讨骶前区静脉的解剖和骨盆骨折大出血的关系。方法结合50例骨盆骨折伴盆腔内血管损伤出血临床病例救治,选成年尸体标本5具,研究骶前区静脉走行,骶骨的解剖学特点,骨折部位与出血的关系。结果骶前区静脉由骶前静脉丛和骶椎椎体静脉组成,有广泛的侧支循环,骶骨C区骨折及严重的B区骨折易损伤骶前静脉丛。临床骶前静脉出血者经剖腹探查证实、止血。结论骶骨C区骨折及严重的B区骨折易引起骶前静脉丛损伤。一旦确诊应立即恢复骨盆环的完整性,腹外加压止血,非必要时不能行剖腹探查止血。

Objective To investigate the anatomy of the anterior sacral veins and the association between hemorrhage in pelvic fractures and the anterior sacral veins. Methods Based on the clinical care of 50 cases of pelvicfractures with serious hemorrhage,five embalmed bodies were harvested to study the anatomy of the anterior sacral veins, and the relationship between the fracture and the hemorrhage. Results The anterior sacral veins consist of the venous plexus of presacral region and conus veins of sacral vertebrae. The sacrum fractures of zones B and C can injure the anterior sacral veins and result in serious hemorrhage. 3 cases of hemostasis ofter injury of the anterror sacral veins were diagnosesed and controlled by exploratory operation or celiolomy. Conclusions The sacrum fractures of zones B and C can injure the anterior sacral veins and result in serious hemorrhage.Once the pelvic fracture has been confirmed, immediate care should be taken to restore the integrity of the pelvic ring, hemostasis should be done under compression outside the abdomin but can not be done through exploratory operation or celiolomy unless it is necessary.