【摘要】 目的为髂腹股沟入路在骨盆骨折手术中避免神经血管损伤提供解剖学依据。方法在15具(男9具,女6具)30侧成尸标本上选择髂前上棘、耻骨结节和腹股沟韧带为标志观测股外侧皮神经(Lateral femoral cutaneous nerve,LFCN)、髂腹股沟神经(Ilioinguinal nerve,IN)、股神经耻骨肌支和闭孔动脉(Obturator artery,OA)的走形特点,所测数据统计学处理。结果①LFCN在髂前上棘内侧穿出腹股沟韧带占96.67%(29/30侧),距髂前上棘中心点(20.01±0.32)mm;被腹股沟韧带纵横纤维所包裹的占33.33%(10/30侧);在阔筋膜形成的筋膜鞘中走行占46.67%(14/30侧)。②IN穿出腹内斜肌部位距离髂前上棘中心点为(5.41±0.50)mm,穿出腹外斜肌腱膜部位距离耻骨结节中心点为(18.04±0.21)mm。结论在显露髂骨翼内侧面和骶髂关节时,应在LFCN走行的阔筋膜和腹股沟韧带部位进行显露和预防性松解,以免牵拉损伤;切开腹外斜肌腱膜时应从腹股沟韧带两端上方5 mm处开始,防止损伤深面的IN。在显露髂耻隆起时先寻找和结扎闭孔血管耻骨支,以免引起不可控制的出血。更多还原

【Abstract】 Objectives To provide applied anatomic data for preventing the injury of the important structures in the ilioinguinal approach of surgical treatment forpelvic fracture. Methods the anterior superior iliac spine, the pubic tubercle and the inguinal ligament were chosen as the mark point for observing and measuring morphologic features of lateral femoral cutaneous nerve, ilioinguinal nerve, pectineus branch of the femoral nerve and obturator artery in 15 adult cadaveric specimens(30 sides, 9 male, 6 female). The data were analyzed statistically. Results ① LFCN traveled medial to anterior superior iliac spine through the inguinal ligament could be observed in 29 sides(96.67%),(20.01 ± 0.32)mm; LFCN was surrounded by the fibers of the inguinal ligament could be observed in 10 sides(33.33%); LFCN was covered by a fascial sheath formed by the deep fascia could be observed 14 sides(46.67%). ② The distance between the point of ilioinguinal nerve passed through the obliquus internus abdominis and the center of the anterior superior iliac spine was(5.41 ± 0.50) mm, The distance between the point of ilioinguinal nerve penetrated from the aponeurosis of oblique externus abdominis and the center point of pubic tubercle was(18.04 ± 0.21) mm. Conclusion The LFCN must be protected in the exposure of the medial side of the iliac wing and sacroiliac joint by preventive release of the tensor fascia and the inguinal ligament. To prevent the injury to ilioinguinal nerve, incision of the aponeurosis of the oblique externus abdominis should be performed at 5cm superior to medial and lateral ends of the inguinal ligaments. Identification and ligation of the obturator vessels to ramus of pubis should be carried out prior to exposure of iliopectineal eminence so that uncontrollable bleeding can be avoided更多还原