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目的为髋臼骨折髂腹股沟下入路血管损伤、术后血栓及淋巴漏的预防提供解剖学依据。方法 20具(男女各10具,40侧)国人尸体标本,参照临床手术步骤解剖,观察和测量与髂腹股沟下入路中间窗显露相关结构的特点及关系。结果腹壁下动脉23侧(57.5%)起自髂外动脉,7侧(17.5%)起自股动脉,起点距耻骨联合中点(41.35±2.33)mm,与髂外动脉夹角约(40.23±5.23)°,左右侧差异无统计学意义(P>0.05),且与骨盆纵径及半骨盆横径不相关(P>0.05)。髂血管周围无明确筋膜鞘样结构,血管和淋巴易受到牵拉损伤;股血管有明显鞘样结构,但与周围结构连接疏松易分离。髂耻弓起始处与腹股沟韧带内侧半呈(15.20±6.79)°锐性夹角,有少量菲薄膜样结构,易分离。髂筋膜内下部较厚,且厚度与骨盆纵径及半骨盆横径不相关(P>0.05)。结论髂腹股沟入路和髂腹股沟下入路中间窗显露时均易伤及血管和淋巴管,髂筋膜下部和髂耻弓结构致密,可从髂筋膜下分离与内侧窗贯通。
Objective To provide an anatomical basis for the prevention of vascular injury of the iliovaginal groin in the treatment of acetabular fractures and the prevention of postoperative thrombus and lymphatic drainage. Methods Twenty female cadavers (10 males and 40 females) were dissected, and the characteristics and relationships of the structures related to the middle window of ilio-invaginal approach were observed and measured with reference to clinical surgical procedures. Results The inferior abdominal artery (57.5%) originated from the external iliac artery and the 7 sides (17.5%) from the femoral artery. The starting point was (41.35 ± 2.33) mm from the midpoint of the pubic symphysis, and the angle with the external iliac artery was (40.23 ± 5.23) °. There was no significant difference between the left and right sides (P> 0.05), and was not related to the longitudinal and semi-pelvic diameter (P> 0.05). There was no definite fascia-like structure around the iliac vessels, and the vessels and lymphadentes were easily damaged by traction; the femoral vessels had obvious sheath-like structure, but loosely connected with the surrounding structures. The beginning of iliopubic arch and inguinal ligament medial half (15.20 ± 6.79) ° sharp angle, a small amount of phenanthrene film-like structure, easy to separate. The lower part of the iliac fascia was thicker and the thickness was not related to the longitudinal and semi-pelvic diameters (P> 0.05). Conclusions Both the iliovaginal groin and the middle window of ilio-invaginal approach are easy to injure the blood vessels and lymphatic vessels. The inferior iliac fascia and ilium-pituitary gland are compact and can be separated from the iliac fascia through the medial window.