Anatomic study on the distance between two insertion points and reproductive structures of retrograde superior ramus intramedullary screw

doi:10.13418/j.issn.1001-165x.2023.2.01

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Chinese Journal of Clinical Anatomy ›› 2023, Vol. 41 ›› Issue (2) : 121-127. DOI: 10.13418/j.issn.1001-165x.2023.2.01

Anatomic study on the distance between two insertion points and reproductive structures of retrograde superior ramus intramedullary screw

Yang Demeng¹, Huo Nianci², Zhou Aoran², Liu Yuan², Liang Shuang², Wang Xueyao², Zhang Hao², Li Zhuangzhi², Ma Jianjun³, Chen Zhiguo³*

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Abstract

Objective To measure the anatomical distance between the insertion point of two different percutaneous retrograde superior ramus of the pubis screw and the surrounding important reproductive structure, and compare the risk of damaging the surrounding important reproductive structure during the insertion of the two insertion points, so as to provide basis for clinical safety of the insertion of the screw. Methods Fourteen anticorrosive adult specimens were selected. With the C arm machine monitoring, bilateral percutaneous retrograde screw needle placement was completed by hand. The entry point of A was selected at the front end of the cortex of the internal margin of the pubis, and the entry point of B was selected at the medial point of the pubic tuberculum in the ventral cortex of the pubis. Imaging monitoring equipment confirmed that all needles were located in the osseous channel. Anatomical specimens were used to expose important reproductive structures. The closest distance between the two insertion points and bilateral spermatic cord, dorsal nerve of penis, and corpus cavernosum of the penis was measured in male specimens. The closest distance between the two insertion points and round uterine ligament, the dorsal nerve of the clitoris, the base of the clitoral body, and the glans of the clitoris was measured in female specimens. Results The average distance between the insertion point A and ipsilateral spermatic cord was (51.17±5.82)mm > the dorsal nerve of penis (20.94±4.16)mm > the contralateral spermatic cord (19.77±5.23)mm > the corpus cavernosum (19.65±7.30)mm. The average distance between the entry point A and the ipsilateral round uterine ligament was (63.12±10.26) mm > the contralateral round uterine ligament (56.11±8.20) mm > the glans of clitoris (40.72±3.30) mm > the dorsal nerve of clitoris (20.46±5.81) mm > the base of clitoral body (17.72±1.76) mm. The mean distance between the insertion point B and the contralateral spermatic cord was (32.22±8.50) mm > the dorsal nerve of penis (31.18±6.23) mm > the ipsilateral spermatic cord (27.09±5.58)mm > penile cavernous body (20.01±7.54)mm. The mean distance between the insertion point B and the clitoral head was (52.80±5.91) mm > the dorsal nerve of clitoris (50.79±5.05) mm > the contralateral round ligament (43.40±6.70) mm > the ipsilateral round ligament (35.04±11.25) mm > the base of the clitoral body (33.99±3.86) mm. Conclusions The risk of injury of the contralateral spermatic cord, the dorsal nerve of penis, in male and the dorsal nerve of clitoris, the base of the clitoral body in female at the insertion point A is higher than that at the insertion point B. For the insertion point B, the possibility of injury to the dorsal nerve of clitoris in male is greater than that of in female, the possibility of injury to the dorsal penile nerve and the base of the clitoral body is greater than that of than the cavernosum of the penis. Caution should be paid when performing the same operation at the same insertion point.

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Yang Demeng, Huo Nianci, Zhou Aoran, Liu Yuan, Liang Shuang, Wang Xueyao, Zhang Hao, Li Zhuangzhi, Ma Jianjun, Chen Zhiguo. Anatomic study on the distance between two insertion points and reproductive structures of retrograde superior ramus intramedullary screw[J]. Chinese Journal of Clinical Anatomy. 2023, 41(2): 121-127 https://doi.org/10.13418/j.issn.1001-165x.2023.2.01

References

[1] Gänsslen A, Pohlemann T, Paul C, et al. Epidemiology of pelvic ring injuries [J]. Injury, 1996: S-A13-20. DOI: 10.1016/0020-1383(96)83789-2.
[2] Rommens PM, Graafen M, Arand C, et al. Minimal-invasive stabilization of anterior pelvic ring fractures with retrograde transpubic screws[J].Injury,2020, 51(2):340-346. DOI: 10.1016/j.injury. 2019. 12.018.
[3] Qoreishi M, Seyyed Hosseinzadeh HR, Safdari F. Clinical Results of Percutaneous Fixation of Pelvic and Acetabular Fractures: A Minimally Invasive Internal Fixation Technique[J]. Arch Bone Jt Surg, 2019, 7(3):284-290. DOI: 10.22038/ABJS.2018.35573.1935.
[4] Dienstknecht T, Müller M, Sellei R, et al. Screw placement in percutaneous acetabular surgery: gender differences of anatomical landmarks in a cadaveric study[J]. Int Orthop,2013,37(4):673-679. DOI: 10.1007/s00264-012-1740-1.
[5] 黄金勇,马超,吾路汗·马汗,等.闭合性骨盆骨折继发勃起功能障碍的危险因素分析[J].中华骨与关节外科杂志, 2021,14(2):135-139. DOI：10.3969/j.issn.2095-9958.2021.02.12.
[6] Metze M, Tiemann AH, Josten C. Male sexual dysfunction after pelvic fracture[J]. Trauma.2007,63(2):394-401. DOI: 10.1097/01.ta. 0000 241145. 02748.df.
[7] 孟昊业, 汪爱媛, 许文静, 等. 逆行螺钉置入固定骨盆耻骨上支骨折的数字解剖学参数[J]. 解放军医学院学报, 2018, 39(6):520-522-550.DOI：10.3969/j.issn.2095-5227.2018.06.016.
[8] 杨勇, 王磊, 王福川, 等. 耻骨上支骨折髓内螺钉进钉通道的数字解剖学研究[J]. 中国临床解剖学杂志, 2013, 31(4):397-401.DOI：10.13418/j.issn.1001-165x.2013.04.022.
[9] Routt ML Jr, Nork SE, Mills WJ. Percutaneous fixation of pelvic ring disruptions[J]. Clin Orthop Relat Res, 2000,(375):15-29. DOI: 10.1097/00003086-200006000-00004.
[10] Gänsslen A, Krettek C. Retrograde transpubic screw fixation of transpubic instabilities[J]. Oper Orthop Traumatol, 2006,18(4):330-40. English, German. DOI: 10.1007/s00064-006-1181-3.
[11] Luksameearunothai K, Amin RM, Shafiq B, et al. Distance Between Reproductive Structures and the Insertion Point of the Retrograde Pubic Ramus Screw[J].J Orthop Trauma, 2020, 34(11):578-582. DOI: 10.1097/BOT.0000000000001804.
[12] Firoozabadi R, Stafford P, Routt M. Risk of Spermatic Cord Injury During Anterior Pelvic Ring and Acetabular Surgery: An Anatomical Study[J]. Arch Bone Jt Surg, 2015,3(4):269-273. DOI: 10.22038/abjs.2015.4303.
[13] Weatherby DJ, Chip Routt ML Jr, Eastman JG. The Retrograde-Antegrade-Retrograde Technique for Successful Placement of a Retrograde Superior Ramus Screw[J]. Orthop Trauma,2017, 31(7):e224-e229. DOI: 10.1097/BOT.0000000000000849.
[14] Acklin YP, Zderic I, Buschbaum J, et al. Biomechanical comparison of plate and screw fixation in anterior pelvic ring fractures with low bone mineral density[J]. Injury,2016, 47(7):1456-1460. DOI: 10.1016/j.injury.2016.04.013.
[15] Winkelhagen J, van den Bekerom MP, Bolhuis HW, et al. Preliminary results of cannulated screw fixation for isolated pubic ramus fractures[J]. Strategies Trauma Limb Reconstr, 2012, 7(2):87-91. DOI: 10.1007/s11751-012-0134-7.
[16] Carmack DB, Moed BR, McCarroll K, et al.Accuracy of detecting screw penetration of the acetabulum with intraoperative fluoroscopy and computed tomography[J]. J Bone Joint Surg Am, 2001, 83(9):1370-5. DOI: 10.2106/00004623-200109000-00012.
[17] 卢洪凯, 袁其华, 王金平, 等.女性尿道括约肌支配神经的应用解剖[J].中国临床解剖学杂志,2007, 24(1):32-34. DOI：10.3969/j.issn.1001-165X.2007.01.011.
[18] Parnell BA, Johnson EA, Zolnoun DA. Genitofemoral and perineal neuralgia after transobturator midurethral sling[J]. Obstet Gynecol,2012, 119(2 Pt 2):428-431. DOI: 10.1097/AOG.0b013e31822c96cb.
[19] Moss CF, Damitz LA, Gracely RH, et al. Dorsal clitoral nerve injury following transobturator midurethral sling[J]. J Pain Res, 2016, 9:727-730. DOI: 10.2147/JPR.S106150.