摘要
目的 :探讨骶骨毗邻结构与骶骨螺钉并发症的关系。方法 :在 5 8具骨盆标本上 ,对第 1骶前孔及骶管结构进行了观测。在 10具标本上 ,模拟骶骨进钉方法的手术过程 ,观察钉道位置与骶骨周围结构的关系。结果 :骶交感干、第 1骶神经与腰骶干围成一个三角形区域 ,在其内侧部无重要结构紧贴骨面走行 ,外侧区有臀上血管走行。此三角前方有髂动、静脉相邻。第 1骶神经粗 (11.0± 2 .8)mm (6.0～ 17.0mm) ,腰骶干粗 (7.6± 2 .2 )mm (3 .0～ 12 .0mm)。当螺钉与矢状面呈向内 0°～ 10°进钉时较为安全。第 1骶后孔可见小血管 ,骶骨外侧沟内有第 5腰椎血管后内侧支走行 ,是术中出血的原因。结论 :骶骨螺钉有损伤骶神经、髂血管的可能 ,5点 7点进钉方法较为安全。
Objective: To discuss the relationship between structures around sacrum and the complications of sacral screw. Methods: The adjacent structures about the sacra were investigated on 58 cadavers, as well as the first anterior sacral foramina and the sacral canal. The simulated operations were performed on 10 cadavers for observing the place of the sacral screw and the relation between the place and structures around the sacrum. Results: The sacral plexus consists of the lumbosacral nerve trunk passing in front of the ala of sacrum crosswise, and the first sacral nerve coming from the first anterior sacral foramina. A safe triangular zone, which is located in front of the sacrum, is made up of the lumbosacral sympathetic trunk, the lumbosacral nerve trunk and the first sacral nerve. The medial part of the zone is safe for no important structure in it; and the superior gluteal artery and vein are in the lateral part of the zone. The iliac artery and vein are the neighbors of the triangular zone. The first sacral nerve has a diameter of (11.0±2.8) mm (6.0～17.0mm); and the lumbosacral nerve trunk is (7.6±2.2) mm (3.0～12.0mm). The sacral screw is safe at 0°～10°inward to the sagittal plane, because its point is located in the medial part of the triangular zone. The cause of bleeding during operation may be the small vessels coming from the first posterior sacral foramina or the posteromedial rami of the fifth lumbar vessel passing through the lateral sulcus of the sacrum. The simulated operations showed the sacral screw was in the body of the sacrum and out of the sacral canal through the five-seven o'clock point. Conclusions: The tip of the sacral screw maybe injury the sacral nerve and the iliac vessels. The placement of sacral screw through the five-seven o'clock point on the articular facet of the superior articular process was a safe and easy method.
出处
《中国临床解剖学杂志》
CSCD
北大核心
2004年第2期139-142,共4页
Chinese Journal of Clinical Anatomy
关键词
骶管
螺钉
骶神经
髂血管
应用解剖
sacral canal
screw fixation
sacral nerve
iliac vessels
applied anatomy
