Department of Orthopaedic Surgery, University of Kansas, Kansas City, KS, USA.
J Orthop Trauma. 2012 May;26(5):263-8. doi: 10.1097/BOT.0b013e31823e6b82.
To determine what anatomic structures are at risk after the application of a subcutaneous anterior pelvic internal fixator (APIF), from an incision over the anterior iliac crest to an incision centered over the pubic symphysis (Pfannenstiel).
A laboratory investigation was performed using 5 fresh, frozen, nonpreserved cadaveric specimens (3 male specimens, 2 female specimens). Dissections were carried out to identify the relationships and proximity between the fixator screw constructs and various anatomic structures, including the (1) lateral femoral cutaneous nerve (LFCN), (2) ilioinguinal nerve (IIN), (3) iliohypogastric nerve (IHN), (4) femoral nerve, (5) femoral artery, (6) femoral vein, (7) genitofemoral nerve; and (8) spermatic cord or round ligament. The mean and range of distance from each of these structures to the implant were measured with calipers.
Despite variations in pelvic anatomy and width of pelvic brims, precontoured fixators (3.5 locking reconstruction plates) did not violate any pelvic neurovascular structures using this recommended application of an APIF. The spermatic cord was easily avoided as they were directly visualized using our application technique (mean, 0.4 cm, range, 0-2 cm). Abdominal musculature protected the IHN and IIN for most of their course, with the precontoured plates remaining inferior to their course and resting superficial to their branches (IHN mean, 1.5 cm, range, 1.2-1.8 cm and IIN mean, 2.1 cm, range, 0.9-4 cm). The LFCN traveled safely posterior to the inguinal ligament, thus being bridged by the internal spanning fixation without visualized disruption, impingement, or violation (mean, 1.5 cm, range, 0.6-4 cm). Finally, the femoral nerve, artery, and vein collectively demonstrated safe distance from the risk of compression (mean, 2.2 cm, range, 0.8-3.7 cm).
The anatomic structures hypothesized to be potentially endangered because of the lack of direct visualization during APIF placement, include the LFCN, IIN, IHN, femoral nerve, femoral artery, and femoral vein. Based upon our anatomic study, APIF, which may be used for treatment augmentation of anterior pelvic ring disruptions, does not place these structures at significant risk. In addition, the reproductive structures (round ligament and spermatic cord) are in direct visualization and can easily be avoided during implant placement.
确定从髂前上棘上方的切口到耻骨联合中心的切口应用皮下前路骨盆内固定器（APIF）后，哪些解剖结构有风险。
使用 5 个新鲜、冷冻、未经保存的尸体标本（3 个男性标本，2 个女性标本）进行实验室研究。进行解剖以确定固定器螺钉结构与各种解剖结构之间的关系和接近程度，包括（1）外侧股皮神经（LFCN）、（2）髂腹股沟神经（IIN）、（3）髂腹下神经（IHN）、（4）股神经、（5）股动脉、（6）股静脉、（7）生殖股神经；和（8）精索或圆韧带。使用卡尺测量这些结构与植入物之间的平均和范围距离。
尽管骨盆解剖结构和骨盆边缘宽度存在差异，但使用这种推荐的 APIF 应用方法，预成型固定器（3.5 个锁定重建板）不会侵犯任何骨盆神经血管结构。使用我们的应用技术，很容易避免精索，因为它们可以直接看到（平均 0.4 厘米，范围 0-2 厘米）。腹部肌肉在大部分行程中保护 IHN 和 IIN，预成型板位于其下方，位于其分支的浅层（IHN 平均 1.5 厘米，范围 1.2-1.8 厘米，IIN 平均 2.1 厘米，范围 0.9-4 厘米）。LFCN 安全地位于腹股沟韧带后方，因此内部跨越固定不会造成可见的中断、撞击或侵犯（平均 1.5 厘米，范围 0.6-4 厘米）。最后，股神经、动脉和静脉共同显示出与受压风险的安全距离（平均 2.2 厘米，范围 0.8-3.7 厘米）。
由于缺乏 APIF 放置过程中的直接可视化，假设潜在危险的解剖结构包括 LFCN、IIN、IHN、股神经、股动脉和股静脉。基于我们的解剖研究，APIF 可用于治疗前骨盆环破裂的增强，不会使这些结构面临重大风险。此外，生殖结构（圆韧带和精索）可以直接看到，在植入物放置过程中很容易避免。
