Luksameearunothai Kitchai, Amin Raj M, Shafiq Babar, Hasenboehler Erik A
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD; and.
Department of Orthopaedic Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
J Orthop Trauma. 2020 Nov;34(11):578-582. doi: 10.1097/BOT.0000000000001804.
To identify the distance between the guidewire for a retrograde pubic ramus screw and critical reproductive structures in men and women.
Twenty hemipelves from 10 fresh-frozen cadavers (pelvis to distal femur) were studied. The mean (±SD) age was 77 ± 6 years for the 5 male cadavers and 71 ± 9 years for the 5 female cadavers. A 2.8-mm guidewire for a cannulated screw was inserted from the parasymphyseal bone using fluoroscopic guidance. The soft tissue was dissected and measurements performed by the first author. In men, we measured the closest distances from the guidewire entry point to the contralateral spermatic cord and corpus cavernosum. In women, we measured the closest distances from the guidewire entry point to the base of the clitoral body and clitoral glans.
In male cadavers, mean distances were 8.8 ± 4.2 mm to the spermatic cord and 13 ± 6.7 mm to the corpus cavernosum. The guidewire did not penetrate these structures in any specimen. In female cadavers, mean distances were 12 ± 5.7 mm to the base of the clitoral body and 40 ± 8.2 mm to the clitoral glans. The guidewire also did not penetrate these structures.
The contralateral spermatic cord and corpus cavernosum in men and the base of the clitoral body in women are close to the pathway of the retrograde ramus screw guidewire. Careful identification of the entry point and avoidance of multiple attempts of guidewire insertion may reduce the risk of injury to these structures.
确定逆行耻骨支螺钉导丝与男性和女性关键生殖结构之间的距离。
研究了来自10具新鲜冷冻尸体（骨盆至股骨远端）的20个半骨盆。5具男性尸体的平均（±标准差）年龄为77±6岁，5具女性尸体的平均年龄为71±9岁。在透视引导下，从耻骨联合旁骨插入一根2.8毫米空心螺钉导丝。由第一作者进行软组织解剖和测量。在男性中，我们测量了从导丝进入点到对侧精索和海绵体的最短距离。在女性中，我们测量了从导丝进入点到阴蒂体基部和阴蒂头的最短距离。
在男性尸体中，到精索的平均距离为8.8±4.2毫米，到海绵体的平均距离为13±6.7毫米。在任何标本中，导丝均未穿透这些结构。在女性尸体中，到阴蒂体基部的平均距离为12±5.7毫米，到阴蒂头的平均距离为40±8.2毫米。导丝也未穿透这些结构。
男性的对侧精索和海绵体以及女性的阴蒂体基部靠近逆行耻骨支螺钉导丝的路径。仔细确定进入点并避免多次尝试插入导丝可能会降低这些结构受损的风险。
