改良Stoppa入路髖臼后柱的解剖學(xué)研究和臨床治療效果分析
發(fā)布時(shí)間：2018-09-07 18:02
【摘要】：目的一、通過骨盆標(biāo)本解剖研究,記錄和測(cè)量骨盆內(nèi)坐骨大切跡后方解剖結(jié)構(gòu)與坐骨大切跡后方的關(guān)系。為臨床使用改良Stoppa入路和應(yīng)用髂坐鋼板技術(shù)提供參考依據(jù)。二、綜合文獻(xiàn)結(jié)果,比較改良Stoppa入路和髂腹股溝入路的臨床治療效果。材料和方法第一部分1.骨盆標(biāo)本由南方醫(yī)科大學(xué)解剖教研室提供8個(gè)骨盆標(biāo)本,6男2女。2.采用改良Stoppa入路,顯露四邊體、后柱內(nèi)壁、坐骨大切跡。辨認(rèn)并測(cè)量骨盆內(nèi)相關(guān)解剖學(xué)參數(shù)。3.使用SPSS行統(tǒng)計(jì)學(xué)分析第二部分1.在PUBMED搜索英文文獻(xiàn),關(guān)鍵詞:在Pubmed上收集髂腹股溝入路和Stoppa入路比較的相關(guān)文獻(xiàn)。關(guān)鍵詞:((“Stoppa Approach”O(jiān)R“Anterior Approach”))AND“Acetabular fracture"2.納入標(biāo)準(zhǔn)為:1.病人普遍年齡大于15歲,小于65歲,不包括兒童和老年人髖臼骨折治療;2.文獻(xiàn)為病例分析資料,比較指標(biāo)需涉及手術(shù)時(shí)間和出血量,骨折復(fù)位率,并發(fā)癥等;3.不包括骨盆骨折、腹直肌旁入路以及特定骨折的治療病例;4.治療方法包括改良Stoppa入路或改良Stoppa入路與髂腹股溝入路的治療病例分析;5.英文文獻(xiàn);6.2010年以后發(fā)表的文獻(xiàn)。3.收集文獻(xiàn)資料數(shù)據(jù),總結(jié)并分析結(jié)果。結(jié)果1.改良Soppa入路髖臼后柱解剖測(cè)量1.1死亡冠血管6例均可見單根死亡冠血管,均為靜脈型,從腹壁下靜脈發(fā)出。1例雙側(cè)未見死亡冠血管和變異閉孔血管。1例死亡冠血管缺如,由變異的閉孔血管代替(圖1-1)。死亡冠血管距離恥骨聯(lián)合48±5.5mm。變異閉孔血管為單根動(dòng)脈和單根靜脈,從髂內(nèi)血管主干發(fā)出。變異閉孔動(dòng)脈外徑為3.2mm,變異閉孔靜脈為6.3mm,與恥骨聯(lián)合的距離分別為45mm,48mm。1.2閉孔神經(jīng)血管束靜息下,閉孔神經(jīng)與骨盆緣距離14.6±2.4mm,閉孔動(dòng)脈與骨盆緣距離19.3±1.5mm,閉孔靜脈與骨盆緣距離25.6± 1.7mm。在坐骨小切跡位置牽拉下,閉孔神經(jīng)與骨盆緣的距離19.5±1.8mm,閉孔動(dòng)脈與骨盆緣距離30.1 ±2.6mm,閉孔靜脈與骨盆緣距離39.2 ±3.8mm。1.3臀上神經(jīng)血管束臀上神經(jīng)血管束位于坐骨大切跡頂點(diǎn)后方,7例標(biāo)本從前向后的解剖順序是臀上神經(jīng)、臀上動(dòng)脈、臀上靜脈,1例標(biāo)本左側(cè)臀上動(dòng)脈位于最前方。臀上神經(jīng)血管束與坐骨大切跡頂點(diǎn)距離8.6 ±2.2mm,臀上動(dòng)脈外徑4.3 ±0.6mm。1.4坐骨神經(jīng)坐骨神經(jīng)上緣投影點(diǎn)到坐骨大切跡頂點(diǎn)距離15.4±2.5mm,坐骨神經(jīng)下緣投影點(diǎn)與坐骨棘上5.6±3.5mm,坐骨神經(jīng)中點(diǎn)到坐骨大切跡后緣約為3.4±1.2mm。1.5陰部?jī)?nèi)動(dòng)脈和陰部神經(jīng)陰部?jī)?nèi)動(dòng)脈與坐骨大切跡距離3.6±1.5mm,血管外徑2.3±0.8mm。陰部神經(jīng)位于陰部?jī)?nèi)動(dòng)脈內(nèi)側(cè)或內(nèi)下方。2.改良Stoppa入路和髂腹股溝入路臨床治療效果比較1、根據(jù)搜索關(guān)鍵詞((Stoppa Approach)OR(AnteriorApproach))AND(Acetabular Fracture),得到初始搜索結(jié)果204個(gè),根據(jù)納入標(biāo)準(zhǔn),排除不符合結(jié)果,最終得到共10篇英文文獻(xiàn),其中4篇是Stoppa入路與髂腹股溝入路臨床治療病例的比較性分析。結(jié)論1、閉孔神經(jīng)血管束在坐骨小切跡位置可被牽拉,提供手術(shù)操作空間,但需注意牽拉張力。2、坐骨大切跡頂點(diǎn)與后方臀上神經(jīng)血管束以及下方坐骨神經(jīng)近存在安全區(qū)域,可以作為顯露或復(fù)位支點(diǎn)。3、坐骨大切跡后緣與坐骨神經(jīng)存在一定距離,在該位置放置復(fù)位器時(shí)仍需減少后方移動(dòng),髖關(guān)節(jié)呈伸直或過伸位可減少坐骨神經(jīng)張力。4、坐骨棘水平后方的陰部?jī)?nèi)動(dòng)脈與坐骨大切跡極為接近,需要小心保護(hù)。5、改良Stoppa入路在四邊體和髖臼后柱更寬闊的視野,可更合理的放置鋼板,治療涉及雙柱骨折可能治療效果更好。解剖結(jié)構(gòu)簡(jiǎn)單易于掌握。但對(duì)于已經(jīng)熟練掌握髂腹股溝入路的骨科醫(yī)生,使用兩種入路的治療效果無明顯差別。
[Abstract]:Objective First, to record and measure the relationship between the posterior anatomical structure of the greater pelvic ischial notch and the posterior of the greater ischial notch through the anatomical study of pelvic specimens. Pelvic specimens were provided by the Department of Anatomy, Southern Medical University. Eight pelvic specimens, six males and two females, were obtained. 2. The improved Stoppa approach was used to expose the tetrahedron, posterior column wall, and large ischial notch. The inclusion criteria were: (Stoppa Approach OR "Anterior Approach") and "Acetabular fracture" 2. Patients were generally older than 15 years and younger than 65 years, excluding the treatment of acetabular fractures in children and the elderly; 2. Literatures were case reports. Analysis of data, comparative indicators need to be related to operation time and bleeding volume, fracture reduction rate, complications, etc. 3. Exclude pelvic fractures, rectus abdominis accessory approach and specific fracture treatment cases; 4. Treatment methods include modified Stoppa approach or modified Stoppa approach and ilioinguinal approach treatment case analysis; 5. English literature; 6. 2010 onwards; 6. Results 1. Single dead coronary artery was found in 6 cases of 1.1 deaths by modified Soppa approach, all of which were venous and originated from the inferior epigastric vein. No dead coronary artery or obturator vessel was found on both sides of the abdomen. The diameter of the obturator artery was 3.2 mm, the variator obturator vein was 6.3 mm, and the distance from the pubic symphysis was 45 mm, 48 mm.1.2, respectively. The distance between the obturator artery and the pelvic margin was 19.3 + 1.5 mm, the distance between the obturator vein and the pelvic margin was 25.6 + 1.7 mm, the distance between the obturator nerve and the pelvic margin was 19.5 + 1.8 mm, the distance between the obturator artery and the pelvic margin was 30.1 + 2.6 mm, the distance between the obturator vein and the pelvic margin was 39.2 + 3.8 mm, and the distance between the obturator vein and the pelvic margin was 39.2 + 3.8 mm The superior gluteal nerve vascular bundle was located at the rear of the apex of the great sciatic notch. The anatomical order of 7 cases was superior gluteal nerve, superior gluteal artery and superior gluteal vein. The left superior gluteal artery was located at the front of the great sciatic notch. The distance between the superior gluteal nerve vascular bundle and the apex of the great sciatic notch was 8.6 (?) 2.2 mm, and the external diameter of the superior gluteal artery was 4.3 (?) 0.6 mm.1. The distance from the projection point of the superior margin to the apex of the great sciatic notch was 15.4 (+ 2.5mm), from the projection point of the inferior margin of the sciatic nerve to the superior sciatic spine was 5.6 (+ 3.5mm), from the middle point of the sciatic nerve to the posterior margin of the great sciatic notch was 3.4 (+ 1.2mm). Comparisons of clinical outcomes between modified Stoppa approach and ilioinguinal approach 1. According to search keywords (Stoppa Approach OR (Anterior Approach)) and (Acetabular Fracture), 204 initial search results were obtained. According to inclusion criteria, a total of 10 English literatures were obtained, 4 of which were S. Conclusion 1. Obturator nerve and blood vessel bundles can be pulled at the position of small sciatic notch to provide operation space, but attention should be paid to the tension. 2. There is a safe area near the apex of the great sciatic notch to the posterior superior gluteal nerve and blood vessel bundles and the inferior sciatic nerve. 3. There is a certain distance between the posterior margin of the great sciatic notch and the sciatic nerve. The posterior movement of the sciatic nerve should be reduced when the sciatic nerve is placed in this position. The tension of the sciatic nerve can be reduced by extending or overextending the hip. 4. The internal pudendal artery behind the level of the sciatic spine is very close to the great sciatic notch. 5. Modified Stoppa insertion is needed. The anatomy is simple and easy to grasp, but there is no significant difference between the two approaches for orthopedists who have mastered the ilioinguinal approach.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3;R322
本文編號(hào)：2229011
[Abstract]:Objective First, to record and measure the relationship between the posterior anatomical structure of the greater pelvic ischial notch and the posterior of the greater ischial notch through the anatomical study of pelvic specimens. Pelvic specimens were provided by the Department of Anatomy, Southern Medical University. Eight pelvic specimens, six males and two females, were obtained. 2. The improved Stoppa approach was used to expose the tetrahedron, posterior column wall, and large ischial notch. The inclusion criteria were: (Stoppa Approach OR "Anterior Approach") and "Acetabular fracture" 2. Patients were generally older than 15 years and younger than 65 years, excluding the treatment of acetabular fractures in children and the elderly; 2. Literatures were case reports. Analysis of data, comparative indicators need to be related to operation time and bleeding volume, fracture reduction rate, complications, etc. 3. Exclude pelvic fractures, rectus abdominis accessory approach and specific fracture treatment cases; 4. Treatment methods include modified Stoppa approach or modified Stoppa approach and ilioinguinal approach treatment case analysis; 5. English literature; 6. 2010 onwards; 6. Results 1. Single dead coronary artery was found in 6 cases of 1.1 deaths by modified Soppa approach, all of which were venous and originated from the inferior epigastric vein. No dead coronary artery or obturator vessel was found on both sides of the abdomen. The diameter of the obturator artery was 3.2 mm, the variator obturator vein was 6.3 mm, and the distance from the pubic symphysis was 45 mm, 48 mm.1.2, respectively. The distance between the obturator artery and the pelvic margin was 19.3 + 1.5 mm, the distance between the obturator vein and the pelvic margin was 25.6 + 1.7 mm, the distance between the obturator nerve and the pelvic margin was 19.5 + 1.8 mm, the distance between the obturator artery and the pelvic margin was 30.1 + 2.6 mm, the distance between the obturator vein and the pelvic margin was 39.2 + 3.8 mm, and the distance between the obturator vein and the pelvic margin was 39.2 + 3.8 mm The superior gluteal nerve vascular bundle was located at the rear of the apex of the great sciatic notch. The anatomical order of 7 cases was superior gluteal nerve, superior gluteal artery and superior gluteal vein. The left superior gluteal artery was located at the front of the great sciatic notch. The distance between the superior gluteal nerve vascular bundle and the apex of the great sciatic notch was 8.6 (?) 2.2 mm, and the external diameter of the superior gluteal artery was 4.3 (?) 0.6 mm.1. The distance from the projection point of the superior margin to the apex of the great sciatic notch was 15.4 (+ 2.5mm), from the projection point of the inferior margin of the sciatic nerve to the superior sciatic spine was 5.6 (+ 3.5mm), from the middle point of the sciatic nerve to the posterior margin of the great sciatic notch was 3.4 (+ 1.2mm). Comparisons of clinical outcomes between modified Stoppa approach and ilioinguinal approach 1. According to search keywords (Stoppa Approach OR (Anterior Approach)) and (Acetabular Fracture), 204 initial search results were obtained. According to inclusion criteria, a total of 10 English literatures were obtained, 4 of which were S. Conclusion 1. Obturator nerve and blood vessel bundles can be pulled at the position of small sciatic notch to provide operation space, but attention should be paid to the tension. 2. There is a safe area near the apex of the great sciatic notch to the posterior superior gluteal nerve and blood vessel bundles and the inferior sciatic nerve. 3. There is a certain distance between the posterior margin of the great sciatic notch and the sciatic nerve. The posterior movement of the sciatic nerve should be reduced when the sciatic nerve is placed in this position. The tension of the sciatic nerve can be reduced by extending or overextending the hip. 4. The internal pudendal artery behind the level of the sciatic spine is very close to the great sciatic notch. 5. Modified Stoppa insertion is needed. The anatomy is simple and easy to grasp, but there is no significant difference between the two approaches for orthopedists who have mastered the ilioinguinal approach.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3;R322
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 蔣電明 ,余學(xué)東 ,安洪 ,梁勇 ,梁安霖;Hip and pelvic fractures and sciatic nerve injury[J];Chinese Journal of Traumatology;2002年06期
，本文編號(hào)：2229011
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