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目的探讨经腹直肌外侧切口入路治疗髋臼骨折的安全性及临床应用价值。方法新鲜成人尸体标本5具(3男2女),同一尸体右侧腹壁行大体解剖,熟悉入路周围的解剖结构,左侧应用腹直肌外侧切口入路,模拟术中操作,显露骨盆环,进行解剖学观察,重点测量记录死亡冠血管相关解剖学参数。结果 (1)经腹直肌外侧入路的显露范围包括:耻骨联合至骶髂关节在内的真性骨盆环、髂骨翼、髋臼方形区和坐骨体内侧的髋臼后柱大部分。(2)根据对5具10侧骨盆的死亡冠统计分析发现,死亡冠的出现率为80%(8侧),直径为(2.1±1.9)mm,长为(4.7±0.5)cm,距离耻骨联合的距离为(4.9±0.4)cm。男女之间差异无明显统计学意义。结论经腹直肌外侧切口入路治疗髋臼骨折能够在不损伤重要神经血管的条件下,经腹膜外间隙对包括骶髂关节在内的大部分骨盆环结构进行显露。尤其方便显露结扎死亡冠,对髋臼后柱及髋臼内侧方形区的显露较传统入路有明显优势。
Objective To investigate the safety and clinical value of lateral rectus incision in treatment of acetabular fractures. Methods Five fresh adult cadaver specimens (3 males and 2 females) were dissected, the right abdominal wall of the same corpse was dissected, the anatomy around the approach was applied, the left lateral rectus incision was used to simulate the intraoperative operation and expose the pelvic ring , Anatomical observation, focusing on measuring the death of the coronary artery related anatomical parameters. Results (1) The exposed area of the lateral approach to the rectus abdominis included the true pelvic ring from the pubic symphysis to the sacroiliac joint, the ilium wing, the acetabular square and the posterior column of the acetabulum. (2) According to the statistical analysis of the death crowns of 5 pelvis with 10 sides, the incidence of death crowns was 80% (8 sides), the diameter was (2.1 ± 1.9) mm and the length was (4.7 ± 0.5) cm, The combined distance is (4.9 ± 0.4) cm. The difference between men and women was not statistically significant. Conclusions The treatment of acetabular fractures through lateral incision of the rectus abdominis can expose most of the pelvic ring structures including the sacroiliac joint via the extraperitoneal space without damaging the important neurovascular. In particular, it is convenient to expose the crown of the ligation and death, revealing the medial posterior column of the acetabulum and the acetabulum has obvious advantages over the traditional approach.