骶髂关节骨折脱位致周围血管神经损伤的临床解剖学基础

目的探讨骶髂关节骨折脱位致血管神经损伤的解剖学基础。方法在20具防腐固定的国人成人尸体骨盆标本上,对髂内外血管及其分支的走行特点、侧支吻合情况、血管外径、到骨壁的距离、及腰骶丛神经行走特点及距骶髂关节的距离,进行解剖学观测。结果髂腰动脉横跨骶髂关节处的外径为（2.42±0.34）mm,此处距骨壁的平均距离为（2.48±0.38）mm,臀上动脉、臀下动脉出骨盆处的外径为（3.69±0.3）mm,（4.08±0.4）mm。结论骶髂关节骨折脱位时最容易损伤的动脉为臀上动脉和髂腰动脉,最容易损伤的神经为腰骶干,伴耻骨骨折时极易损伤闭孔动脉,不易损伤闭孔神经。前路手术要特别注意医源性血管神经的损伤。

Clinical Anatomy of Sacroiliac Joint Fracture-dislocation with Arterial and Never Injuries

Objective To study the mechanisms of the sacroiliac joint fracture-dislocation with artery and nerve injuries,and to provide anatomical basis for pre-surgery treatment in fracture-dislocation of sacroiliac joint.Methods In 20 adult pelvic specimens fixed with formalin,the iliac arterial branches and the characters of pelvic nerves in the sacroiliac region were observed.The diameter of the pelvis and the vertical distance from vessels or nerves to pelvic sides were measured.Results The diameters and distance to pelvic side of the iliolumbar arteries near the sacroiliac joint were （2. 42 ±0. 34）mm and （2. 48± 0. 38）mm respectively. The diameters of the superior and inferior gluteal artery out the pelvis were （3.69 ± 0. 3）mm and （4. 08± 0. 4）mm respectively. Conclusion The iliolumbar arteries, the superior gluteal artery and the lumbosacral trunk are easy to be injured in the sacroiliac joint fracture-dislocation. The fracture of pubis can easily injure the obturator artery but not the obturator nerve. Iatrogenic injury to vessels and nerve in pre-surgery treatment in fracture-dislocation of sacroiliac joint should be avoided.