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解剖研究

doi:10.13418/j.issn.1001-165x.2023.6.01

Abstract

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.

Key words: Modified pararectus abdominis incision; , , Anatomy; , , Local; , , Pubic ramus; , , Anterior approach

CLC Number:

R323.3

Chen Zhuhong, Li Yanbing, Huang Huajun, Lin Xijiang, Zeng Canjun. Anatomical study of posterior pelvic ring injury combined with contralateral anterior pelvic ring injury treated with modified pararectus abdominis incision[J]. Chinese Journal of Clinical Anatomy, 2023, 41(6): 633-639.

References 15

[1]	Christopher H Chu, Lakshika Tennakoon, Paul M Maggio, et al. Trends in the management of pelvic fractures, 2008-2010[J]. J Surg Res, 2016, 202(2): 335-340. DOI: 10.1016/j.jss.2015.12.052.
[2]	Matta JM. Indications for anterior fixation of pelvic fractures[J]. Clin Orthop Relat Res, 1996(329): 88-96. DOI: 10.1097/00003086-199608 000-00011.
[3]	刘勇, 李浩, 李楠, 等. 微创前路钢板内固定技术治疗不稳定性骨盆骨折[J]. 生物骨科材料与临床研究, 2018, 15(3): 29-32. DOI: 10.3969/j.issn.1672-5972.2018.03.007.
[4]	Keel Marius JB, Siebenrock Klaus-Arno, Tannast Moritz, et al. The pararectus approach: a new concept[J]. JBJS Essent Surg Tech, 2018, 8(3): e21. DOI: 10.2106/JBJS.ST.17.00060.
[5]	Zou R, Wu M, Guan J, et al. Clinical results of acetabular fracturevia the pararectus versus ilioinguinal approach[J]. Orthop Surg, 2021, 13(4): 1191-1195. DOI: 10.1111/os.12970.
[6]	何旭辉, 郑潮顺, 郭跃跃, 等. 经腹直肌外侧入路与髂腹股沟入路手术治疗骨盆髋臼骨折的疗效比较[J]. 中国骨与关节损伤杂志, 2020, 35(4): 361-363. DOI: 10.7531/j.issn.1672-9935.2020.04.008.
[7]	阮默, 徐达传, 汪新民, 等. 经皮骶髂螺钉内固定术的应用解剖学研究[J]. 中国临床解剖学杂志, 2006, 24(5): 479-484. DOI: 10.3969/j.issn.1001-165X.2006.05.002.
[8]	Griffin DR, Starr AJ, Reinert CM, et al. Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure[J]? J Orthop Trauma, 2006, 20(1 Suppl): S30-S36. DOI: 10.1097/00005131-200307000-00001.
[9]	Chen H, Wu L, Zheng R, et al. Parallel analysis of finite element model controlled trial and retrospective case control study on percutaneous internal fixation for vertical sacral fractures[J]. BMC Musculoskelet Disord, 2013, 14: 217. DOI: 10.1186/1471-2474-14-217.
[10]	Chen HW, Liu GD, Fei J, et al. Treatment of unstable posterior pelvic ring fracture with percutaneous reconstruction plate and percutaneous sacroiliac screws: a comparative study[J]. J Orthop Sci, 2012, 17(5): 580-587. DOI: 10.1007/s00776-012-0257-1.
[11]	Ayoub MA, Gad HM, Seleem OA. Standalone percutaneous transiliac plating of vertically unstable sacral fractures: outcomes, complications, and recommendations[J]. Eur Spine J, 2016, 25(4): 1153-1162. DOI: 10.1007/s00586-015-3976-0.
[12]	Sagi HC, Militano U, Caron T, et al. A comprehensive analysis with minimum 1-year follow-up of vertically unstable transforaminal sacral fractures treated with triangular osteosynthesis[J]. J Orthop Trauma, 2009, 23(5): 313-321. DOI: 10.1097/BOT.0b013e3181a32b91.
[13]	Zheng J, Xiang J, Feng X, et al. Applicable safety analysis and biomechanical study of iliosacral triangular osteosynthesis[J]. BMC Musculoskelet Dis, 2021, 22(1): 971. DOI: 10.1186/s12891-021-04856-8.
[14]	Li CL. Clinical comparative analysis on unstable pelvic fractures in the treatment with percutaneous sacroiliac screws and sacroiliac joint anterior plate fixation[J]. Eur Rev Med Pharmacol Sci, 2014, 18(18): 2704-2708. DOI: 10.3969/j.issn.1003-6350.2012.15.019.
[15]	黄伟奇, 杨晓东, 李涛. 骶髂关节周围腰骶丛神经的解剖学研究及其临床意义[J]. 中国临床解剖学杂志, 2017, 35(6): 615-617, 627. DOI: 10.13418/j.issn.1001-165x.2017.06.004.

Anatomical study of posterior pelvic ring injury combined with contralateral anterior pelvic ring injury treated with modified pararectus abdominis incision

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References 15

Related Articles 15

Metrics

Comments

Recommended 0

[1]	Jiang Jianhong, Duan Renpeng, Li Xiaofeng. Application of three-dimensional visualization technology in the anatomical variations of hilar bile ducts in Chinese population [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 1-4.
[2]	Guo Hongzhi, Wang Yu, Zhang Jiaqi, Liang Haibin, Ma Ziwei, Feng Wei, Wu You, Si Ziyi. Evaluation of placental vascular structure in preeclampsia by vascular casting combined with CT three-dimensional model [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 5-10.
[3]	Li Jiawei, Zhang Jing, Li Canran, Lan Wenjie, Ji Qingyu, Guo Zhiyong, Zhang Yunfeng, Liu Qi, Chen Qingwei, Li Xiaohe. X-ray measurement of proximal femur anatomical parameters in Mongolian population [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 11-16.
[4]	. Digital measurement and clinical significance of occipitocervical Angle and posterior occipitocervical Angle in children and adolescents [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 17-20.
[5]	Li Wen, Yang Siyi, Huang Lei, Qing Jiwen, Jiang Songtao, Zhang Lei. Morphological characteristics and clinical significance of Lisfranc ligament based on MRI [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 21-25.
[6]	Li Fanfan, Xu Yang, Wang Xiaoxu. Therapeutic effect of shikonin on the treatment of granuloma lobular mastitis in model rats by regulating Nrf2/HO-1 signaling pathway [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 26-32.
[7]	Wang Xinghang, Ding Jiayuan, Li Fang, Bao Cuifen, Yan Lijing. Ginsenoside Rg1 reduces the inflammatory response of microglia after oxygen glucose deprivation/resupply by inhibiting the NLRP3 inflammasome pathway [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 33-41.
[8]	Cheng Yingying, Wu Jianjun, Cai Haiyan , Jiao Xunwen, Ma Jiangbo, Ding Yinxiu. Activation and functional changes of astrocytes cultured in vitro under inflammatory stimulation [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 42-46.
[9]	Qi Zhi, Yang Li, Jia Qiuye, Chen Haolun, Duan Zhaoda, Wu Chunyun. Edaravone regulates Sirt3 expression in lipopolysaccharide-activated microglia via MAPKs signaling pathway [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 47-53.
[10]	Zhang Jingjing, Wang Hongxin. Protective effect of Baicalin on rats with pulmonary hypertension through PDGF/P38 MAPK signaling pathway [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 54-58.
[11]	Yue Qin, Chen Rongli, Xiong Jingxi, Wang Tingyi, Cai Zhiheng, Yi Qiushi, Zeng Xinyi. Effect of Bletilla striata polysaccharides on the choke-area of cross-boundary flap in rats [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 59-64.
[12]	Li Xiaoyu , Zhang Lei , Fu Lei , Li Dongbo , Wang Guoyou. Finite element study on the treatment of Sanders type II calcaneal fracture with three-step reduction method [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 65-70.
[13]	Wu Yanfei, Ma Jianxiong, Lu Bin, Wang Ying, Bai Haohao, Jin Hongzhen, Ma Xinlong. Study on the correlation between the reconstruction of grayscale values using CT post-processing technology and the compressive strength of the endplate [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 71-76.
[14]	Zhuang Wanqiang, Tang Yi, Luo Yonggang, Zhang Hui. An early and mid-term retrospective study of the effects of arthroscopy combined with high tibial osteotomy on patellar position and patellofemoral joint function [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 77-82.
[15]	Luo Ying, Dou Weiyu, Wu Xiaohang, Chen Jingkun, Peng Changgui, Pan Jianying . Risk factors of postoperative complications of calcaneal fractures treated with hippocampal plate internal fixation through minimally invasive method [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 83-88.