骨盆骨折血管损伤的解剖学基础

目的：探讨骨盆骨折血管损伤的机制。方法：20具新鲜成年国人骨盆标本，采用前后双侧入路解剖，观察髂内外血管的走行特点、分型与骨盆韧带、骶丛神经的关系，观察血管在骨盆壁上的投影位置，测量每一根血管到骨壁的垂直距离，观察各动脉间的侧支吻合情况。结果：骨盆动脉血管根据口径可分为3类：(1)小口径动脉，直径小于3．0mm。(2)中等口径动脉，直径3．0～5．0mm。(3)大口径动脉，直径大于5．0mm。据血管距骨壁的距离可分为靠近骨壁的血管(平均距离小于10．0mm)及远离骨壁的血管(平均距离大于10．0mm)。阴部内动脉与骨壁关系不明显。骨盆动脉分支间有广泛的吻合支。结论：骨盆动脉解剖学特点决定了在骨盆骨折中损伤的机率，骨盆动脉有广泛吻合支是骨盆动脉出血止血困难的原因。

Applied anatomy of pelvic fractures with arterial injuries

Object: To study the mechanisms and methods of diagnosis and treatment of the pelvic artery injuries. Methods: The study was performed in 20 specimens of Chinese cadaveric pelvic specimens .We observed the relationship between the patterns of the iliac arterial branches and type with the pelvic ligaments and sacral nerves, and observed the location of the pelvic vessels on the pelvic sides , and measured the vertical distance from vessels to pelvic sides ,and observed the collateral circulations of the pelvic arteries. Results: The diameter of the pelvic arteries which were shorter than 3 mm were iliac lumbar artery, lateral sacral artery , obturator artery. The pelvic arteries of diameter from 3 to 5 mm were superior gluteal artery, inferior gluteal artery, internal pudendal artery. The pelvic arteries of diameter bigger than 5mm were common iliac artery, internal iliac artery, external iliac artery. The arteries of vertical distance from pelvic arteries to pelvic sides greater than 10 mm were common iliac artery, internal iliac artery and external iliac artery, and that smaller than 10 mm were iliac lumber artery, obututor artery, lateral sacral artery, superior gluteal artery and inferior gluteal artery. Conclusions: The anatomic characteristics of pelvis are associated with the injured vessels. The extensive collateral circulations of the pelvic arteries contribute to the hardship of treating pelvic fractures with vascular injury.