Kashyap Sandeep, Diwan Yogesh, Mahajan Shweta, Diwan Deepa, Lal Mukand, Chauhan Randhir
Department of Orthopaedics, Indira Gandhi Medical College, Shimla, India.
Department of Anatomy, Indira Gandhi Medical College, Shimla, India.
Hip Pelvis. 2019 Mar;31(1):40-47. doi: 10.5371/hp.2019.31.1.40. Epub 2019 Mar 5.
Corona mortis is an abnormal arterial or venous anastomosis between the external iliac and the obturator system of vessels and may cause significant hemorrhage during pelvi-acetabular fracture surgeries, hernia repair and laparoscopic gynecological procedures. Previous studies have estimated a prevalence of corona mortis between 34% and 70%. This cadaveric study was conducted to estimate the prevalence of corona mortis in the North Indian population.
Twelve cadavers (24 hemipelvises; 11 males and 1 female) with a mean age of 68 (range, 54-82) years were included in this study.
Corona mortis was observed in 14 hemipelvises (58.3%). A total of 19 (79.2%) vascular anastomoses of diameter greater than 1 mm were observed; 5 hemipelvises (20.8%) had corona mortis on the right side, 9 hemipelvises (37.5%) on the left side and bilateral in 5 (41.7%) cases. Two hemipelvises (8.3%) had an arterial connection. An aberrant obturator artery was observed in 1 (4.2%) hemipelvis. A venous connection was found in 14 specimens (58.3% of hemipelvises). The average distance of the connecting vein from the symphysis pubis was 41 (35-70) mm. A vessel diameter of greater than 4 mm was observed in 4/24 (16.7%) of hemipelvises.
The frequency of venous corona mortis was higher than arterial corona mortis and the majority (83.3%) were small calibre (<4 mm). The presentation pattern and the number of arterial or venous anastomoses were different in the majority of hemipelvises and dissimilar in both hemipelvises of the same cadaver in the majority of cases.
死亡冠是髂外血管与闭孔血管系统之间的一种异常动静脉吻合,在骨盆髋臼骨折手术、疝修补术和腹腔镜妇科手术中可能导致严重出血。既往研究估计死亡冠的发生率在34%至70%之间。本尸体研究旨在估计北印度人群中死亡冠的发生率。
本研究纳入12具尸体(24个半骨盆;11例男性和1例女性),平均年龄68岁(范围54 - 82岁)。
在14个半骨盆(58.3%)中观察到死亡冠。共观察到19处(79.2%)直径大于1mm的血管吻合;5个半骨盆(20.8%)右侧有死亡冠,9个半骨盆(37.5%)左侧有死亡冠,5例(41.7%)为双侧。2个半骨盆(8.3%)有动脉连接。在1个(4.2%)半骨盆中观察到异常闭孔动脉。在14个标本(占半骨盆的58.3%)中发现静脉连接。连接静脉距耻骨联合的平均距离为41(35 - 70)mm。在4/24(16.7%)的半骨盆中观察到血管直径大于4mm。
静脉死亡冠的发生率高于动脉死亡冠,且大多数(83.3%)为小口径(<4mm)。大多数半骨盆中动静脉吻合的表现形式和数量不同,且在大多数情况下同一具尸体的两个半骨盆也不相同。