目的 解剖实验验证单一改良腹直肌旁切口治疗骨盆后环损伤合并对侧前环损伤的安全性及可行性。 方法 收集大体标本3具，采用改良入路单切口显露同侧前后环并延伸至对侧前环，观察显露范围及对侧死亡冠、髂血管，收集相关数据，模拟复位固定，评价安全性及有效性。 结果 显露范围：同侧内侧可至腹中线，后内侧可至S1椎体对侧缘，头侧延伸至L5椎体，真骨盆内可达S1孔，外侧显露同经典入路；对侧外侧可至对侧髂耻隆起，头侧可至对侧四方体上前方，深部达闭孔外上1/2。改良入路可显露同侧骶髂关节及对侧耻骨上支，直视下处理后环及对侧前环损伤。切口总长（7.84±0.18）cm，对侧死亡冠、髂前上棘与耻骨联合的距离分别为（57.07±1.04）、（67.43±0.87）cm。 结论 单一改良腹直肌旁切口治疗同侧骨盆后环损伤合并对侧前环损伤安全、有效，有显著的微创及视野优势。
Abstract
Objective To validate the safety and feasibility of the modified pararectus abdominis approach in the treatment of posterior pelvic ring injury and contralateral anterior ring injury in one incision through anatomical experimentation. Methods Three specimens of cadaver were collected. A modified pararectus abdominis approach with a single incision was used to expose the ipsilateral anterior and posterior pelvic rings and extend to the contralateral anterior pelvic ring. The safety and efficacy of this method was evaluated by assessing the extent of exposure and potential risks to adjacent structures, such as the iliac vessels and corona mortis in the contralateral side, examining the structures exposed, simulating fixation, and collecting relevant data and images. Results The ipsilateral exposure range: This approach extended medially to the midline of the abdomen, reached posteriorly the contralateral edge of the S1 vertebral body, while anteriorly extended to the L5 vertebral body, while it reached the S1 foramen in the true pelvis when exposing caudally. The contralateral exposure range: the contralateral side of the incision could be accessed until reaching the opposite iliopubic eminence. Heading towards the quadrilateral area of acetabulum could expose the medial surface of the contralateral anterior upper part of it, and the depth of the approach extended to upper lateral half of the inner surface of the obturator formamen. Furthermore, the modified approach was effective in revealing the ipsilateral sacroiliac joint and the contralateral pubic ramus while treating the injury of the ipsilateral posterior and contralateral anterior rings under direct visualization. The total incision length was measured at (7.84±0.18) cm, and the distances from the pubic symphysis to the contralateral corona mortis and anterior superior iliac spine recorded as (57.07±1.04) cm and (67.43±0.87) cm, respectively. Conclusions The use of modified pararectus abdominis approach for treating ipsilateral posterior pelvic ring injury and contralateral anterior pelvic ring injury through one incision is a safe and an effective minimally invasive surgical technique that offers advantages in terms of visualization.
关键词
改良腹直肌旁切口； /
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解剖学； /
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局部； /
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耻骨上支； /
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前方入路
Key words
Modified pararectus abdominis incision; /
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Anatomy; /
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Local; /
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Pubic ramus; /
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Anterior approach
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基金
广东省自然科学基金项目（2018A0303130242）；广东省科技计划项目（2018B090944002）
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