耻骨联合的应用解剖、耻骨联合分离钢板内固定的临床研究和双平面钢板的设计

【作者】 崔锡范；

【导师】 周东生；

【作者基本信息】 山东大学 ， 骨外科， 2006， 硕士

【摘要】 目的 通过对耻骨联合比邻结构及耻骨联合骨骼的解剖学研究，为耻骨联合分离钢板内固定提供基础理论依据。方法 选用山东大学医学院解剖学教研室防腐保存的正常成人标本20具(男15具，女5具)。在耻骨联合上缘测量两精索之间的距离及两子宫圆韧带之间的距离。耻骨结节间距，耻骨联合上部厚度，耻骨联合外1cm厚度，耻骨联合外2cm厚度，耻骨联合上下距，耻骨联合外1cm上下距。为手术提供参考。结果 ①耻骨联合上缘两精索间距为65.96±0.42mm，耻骨联合上缘两子宫圆韧带间距为64.62±0.54mm，两者活动度都很大，手术先找到精索或子宫圆韧带并向两侧牵开，即可保护。②冠状动脉是腹壁下动脉和闭孔动脉的吻和支。在耻骨上支的后面，有的人缺如。冠状动脉至耻骨结节的距离为17.12±1.20mm。需要固定耻骨上支，向外延长切口时，注意保护此动脉。③耻骨联合面借纤维软骨板连接而成，耻骨联合面上宽下窄，或呈椭圆形，上部厚男10.54±0.32mm，女11.45±0.29mm，耻骨结节间距为男59.68±0.89mm，女62.67±0.53mm。结论 ①耻骨联合上面耻骨结节至耻骨联合间隙可上3枚螺丝钉。②耻骨联合前面最多每边上2枚螺丝钉。③耻骨联合部两侧中上部骨质较厚，适合上螺丝钉。更多还原

【Abstract】 objective: Supplying basic theoretic basis for internal fixation of pubic symphysis separation steel plate by anatomic study on pubic symphysis neighbor structure and pubic symphysis skeleton. Methods: 20 normal adult specimens (15 males and 15 females) stored in Anatomy Teaching and Research Section of Medical Institute of Shandong University is selected. Distance between two funiculuses on upper edge of pubic symphysis, distance between womb round ligaments, distance between coronary artery and pubis, space between pubic tubercles, thickness of upper part of pubic symphysis, thickness of 1cm position outside pubic symphysis, thickness of 2cm position outside pubic symphysis, upper and lower distance of pubic symphysis and upper and lower distance of 1 cm position outside pubic symphysis are measured to supply reference for operation. Results: (1)Distance between two funiculuses on upper edge of pubic symphysis is 65.96±0.42mm, distance between two womb round ligaments on upper edge of pubic symphysis is 64.62 ±0.54mm, two of them have large movement ranges, so firstly finding funiculus or womb round ligament and extending them before operation can protect them. (2)Coronary artery is proboscis and ramus of inferior epigastric artery and obturator artery. It is behind superior ramus of pubis, some persons don’t have it. Distance between coronary artery and pubic tubercle is 17.12±1.20mm. Superior ramus of pubis shall be fixed, this artery shall be protected when extending gash externally. (3)Pubic symphysis surface is formed by connecting fibrous cartilage, pubic symphysis surface is wide on upper part and is narrow on lower part or it has oval shape, upper part is 10.54 ± 0.32mm for man and is 11.45 ± 0.29mm for woman, distance between pubic tubercles is 59.68 ±0.89mm for man and is 62.67 ±0.53mm for woman. Conclusion: (1) Clearance between pubic tubercle on pubic symphysis and pubic symphysis can be added three screws. (2)Front part of pubic symphysis can be added two screws on each side at the most. ?Middle and upper bone on two sides of pubic symphysis part are thick and is suitable for adding screw.更多还原