Kacra Burkay Kutluhan, Arazi Mehmet, Cicekcibasi Aynur Emine, Büyükmumcu Mustafa, Demirci Serafettin
Department of Orthopedics and Traumatology (BKK), Meram Medical Faculty, Selcuk University, Konya, Turkey.
J Trauma. 2011 Nov;71(5):1340-4. doi: 10.1097/TA.0b013e3182092e8b.
The modified medial Stoppa approach is an alternative and new surgical approach to access to the internal pelvis and medial wall of the acetabulum. There is little information about the clinical anatomic specifications of exposure in the literature. In this study, the pertinent surgical anatomy that involved the modified medial Stoppa approach was further defined and the anatomic positions and variations of the structures seen in the surgical site were analyzed.
We dissected five formalized cadavers to present structures at risk in a standard modified medial Stoppa approach. The internal iliac artery and branches were colored with latex injection in formalized cadavers. Morphometrical measurements of the neurovascular structures adjacent to quadrilateral surface and their anatomic variations were noted.
It was detected that the obturator vessels and nerve and the iliolumbar vessels were primarily the structures at risk. Obturator vessels and nerve were the most important structures to pay attention because of their direct contact to quadrilateral surface. There was communication (corona mortis) between obturator and inferior epigastric veins in 4 (40%) of 10 hemipelvises.
Before clinical applications, performing cadaver dissection is important to minimize intraoperative complications. This study was the first anatomic study in the literature that reveals the structures that are at risk during surgical treatment of acetabular fractures, which was treated with the modified medial Stoppa approach.
改良内侧斯托帕入路是一种用于进入骨盆内部和髋臼内侧壁的新型替代手术入路。文献中关于该入路暴露的临床解剖学细节信息较少。在本研究中，对涉及改良内侧斯托帕入路的相关手术解剖进行了进一步明确，并分析了手术部位所见结构的解剖位置及变异情况。
我们解剖了5具防腐尸体，以展示标准改良内侧斯托帕入路中的风险结构。在防腐尸体中通过乳胶注射对髂内动脉及其分支进行染色。记录四边形表面附近神经血管结构的形态学测量数据及其解剖变异情况。
发现闭孔血管和神经以及髂腰血管是主要的风险结构。闭孔血管和神经因其与四边形表面直接接触而成为最需关注的重要结构。在10个半骨盆中的4个（40%）发现闭孔静脉与腹壁下静脉之间存在交通（死亡冠）。
在临床应用前，进行尸体解剖对于减少术中并发症很重要。本研究是文献中首次揭示采用改良内侧斯托帕入路治疗髋臼骨折手术过程中风险结构的解剖学研究。
