| 1 Objective:The treatment of pelvic trauma involves in surgery, obstetrics and gynecology, urinary surgery and orthopeadics, and it is a big difficulty in clinic. Bleeding is the main cause of death. During medical intervention, series of procedures, such as hemostasis, reduction and fixation, et al. should be done. Because of the special position and complicated anatomic structures of the pelvis, the applied anatomical research lags behind, so there are still many unsolved problem in the link of treatment. Current study researches firstly the blood supply of the pelvis, and (l)On the points of anatomy and radiology, study the trait of the blood supply in pelvis and the regularity of the collateral circulation, provide theoretical basis for angiographic embolization and improve the pertinence and veracity of the embolizational hemostasis. (2)Study the applied anatomy for the plating fixation of sacroiliac joint in anterior approach, which has the widest indication, and for percutaneous iliosacral screw fixation, which is the least traumatic and the most stable fixation method. So providing the guarantee for the safety of operation and its popularization. (3)To study the anatomic behavior and distribution types of lateral femoral cutaneous nerve (LFCN) which is easily incurred iatrogenic injury, and to develop the protocol to diminish the possibility of this kind of injury. (4)Srudy the role of helical CT 2D-MPR and 3D-SSD for diagnosis and treatment direction of the pelvic fracture. Furthermore, establishing foundation for the improvement of the level of the treatment for pelvic trauma, and for gaining the greatest social and economical benefit.2 Material and Methods:30 adult pelvic specimens fixed with formalin, 5 fresh adult pelvises (male 21, female 14), 5 pelvic arteriol cast specimens, 50 blocks of adult dry sacrum and 60 blocks of ilium(left 30, right 30)were used. The following anatomical and radiological study were done.1. Abdomial aorta, inferior vena cava, internal and external iliac artery, internal and external iliac vein, and all their branches were dissected. The rami to the bone of pelvis were counted. The diameter of the main branches were measured, their positon, and the relationship to the iliosacral joint, sacral ala and pedicles were observed.2. To draw assistance from magnifying lens and operating microscope, the arterial anatomosis in pelvis was observed. Intensive patient were pay to the source, branches and the anastomosis of the obturator; The arterial branches and anastomosis in the sacral canal were also observed.3. The L4 and LS nerve roots were dissected. The length and the angle between the nerves and sagital plane were measured. The proximities of both nerves to the sacroiliac joint and to the surface of the sacral ala were recorded. The relationship between sympathetic trunk, lumbar sacral trunk and sacral ala, sacroiliac joint was observed.4. The pelvic segments of LFCN were dissected. The source, course and branches of the nerve were observed, more attention was centred on the site where the nerve leaving the pelvis to the thigh. The distance between the point of its exit and the center of the anterior superior iliac spine was measured.5. The contour of the sacrum and the relationship betweem axis of pedicle and auricular surface of sacroiliac joint were obsearved. The height and thickness of SI, S2 pedicle, the width and thickness of lateral mass, and other operation parameter were determined. Optimal angle and distance for the iliosacral screw through the S1, S2 pedicles were determined on CT film.6. Through the cross-section of the iliosacral joint, the position,orientation and other notices for plate and screw placement were defined.7. Ascertain the starting points for the iliosacral screw on the ilium, and the neighbour structures around the starting point were observed.8. Using GE OEC 9800 DSA system, angiography was performed on 2 hemodynamic instability with pelvic fractures. Angiographic embolization of bleeding...
|
PDF Full Text Request