Fernandes Miguel Loureiro, Dos Santos Diogo Gonçalves, Costa-Santos Cristina, Pereira Pedro A, Pinho André Rodrigues, Leite Maria João
Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
Orthopaedics and Traumathology Department, ULS São João, Porto, Portugal.
Surg Radiol Anat. 2025 Sep 8;47(1):200. doi: 10.1007/s00276-025-03711-y.
Pelvic ring fractures involving the iliopubic rami can cause functional impairment. Percutaneous retrograde fixation is a less invasive procedure when compared to traditional open approaches, however precise anatomical knowledge is crucial for safe screw placement. This study aims to describe the morphology of the iliopubic rami, define a safety corridor for percutaneous screw fixation, specially focusing on the relationships between the iliopubic rami and neurovascular structures.
A retrospective cross-sectional study was conducted on 29 patients using high-resolution computed tomography scans. Measurements included rami shape, narrowest diameter, and distances between the iliopubic rami and neurovascular structures. Statistical comparisons were performed using the Wilcoxon, Mann-Whitney, and Kruskal-Wallis tests.
Triangular and trapezoidal rami shapes were most common being the median narrowest diameter larger in males (8.67 mm) than females (6.83 mm) (p = 0.011). The obturator neurovascular bundle was approximately 3 mm from the iliopubic rami, while the external iliac vein and artery were about 5 mm and 11 mm away, respectively. Women also had a greater external iliac vein proximity to the iliopubic rami on the left, compared to men (p = 0.032).
Therefore, preoperative imaging is essential to reduce neurovascular risks and given anatomical variations, screw selection should be sex-specific, with 6.5 mm screws for males and 4.5 mm for females. The polygonal rami shapes allow the use of straight plates. The obturator neurovascular bundle is highly vulnerable during screw placement as so it is the external iliac vein compared to the homonym artery, especially in women.
涉及髂耻支的骨盆环骨折可导致功能障碍。与传统的开放手术相比，经皮逆行固定是一种侵入性较小的手术，然而精确的解剖学知识对于安全置入螺钉至关重要。本研究旨在描述髂耻支的形态，确定经皮螺钉固定的安全通道，特别关注髂耻支与神经血管结构之间的关系。
对29例患者进行回顾性横断面研究，使用高分辨率计算机断层扫描。测量内容包括支的形状、最窄直径以及髂耻支与神经血管结构之间的距离。使用Wilcoxon、Mann-Whitney和Kruskal-Wallis检验进行统计比较。
三角形和梯形支形状最为常见，男性的中位最窄直径（8.67毫米）大于女性（6.83毫米）（p = 0.011）。闭孔神经血管束距髂耻支约3毫米，而髂外静脉和动脉分别约为5毫米和11毫米。与男性相比，女性左侧髂外静脉也更靠近髂耻支（p = 0.032）。
因此，术前影像学检查对于降低神经血管风险至关重要，鉴于解剖变异，螺钉选择应根据性别而定，男性使用6.5毫米螺钉，女性使用4.5毫米螺钉。多边形支形状允许使用直板。在置入螺钉过程中，闭孔神经血管束极易受损，髂外静脉与同名动脉相比也是如此，尤其是在女性中。
