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目的旨在髓内钉手术进针点术语的标准化,探索股骨近端可靠的骨性标志与周围软组织的解剖学关系。方法查阅关于顺行髓内钉进针点的文献,重点关注“梨状窝”和“转子窝”两个术语。选取国人成人股骨干标本130例,分析转子窝与大转子的关系。选取国人成人尸体下肢标本20例,观察股骨近端软组织附着,测量梨状肌、闭孔内肌和闭孔外肌肌腱相关数据。结果 (1)如果没有梨状窝则转子窝是髓内钉标准的进针点。(2)样本中3.85%的大转子完全不遮挡转子窝,76.15%的大转子包绕转子窝但不遮挡,20.00%部分遮挡。(3)梨状肌纵径和横径的均值分别为(6.74±1.21)mm和(4.29±1.37)mm,闭孔内肌纵径和横径的均值分别为(6.36±1.74)mm和(5.74±1.61)mm,闭孔外肌纵径和横径的平均值分别为(6.26±1.13)mm和(4.57±1.26)mm。(4)梨状肌附着点前、后缘距大转子后缘的距离占大转子长度的百分比分别为(57.9±8.8)%和(43.8±8.7)%,闭孔内肌的分别为(65.6±7.3)%和(52.6±6.9)%。结论所谓的梨状窝应被称为转子窝;因为大转子与转子窝不同的关系,股骨钉的进针点是可变的,转子窝不能被视为通用的进针点;肌腱的定量数据有助于优化手术入路。
The aim is to standardize the terms of nailing for intramedullary nailing and to explore the anatomic relationship between the reliable bone marking proximal to the femur and the surrounding soft tissue. Methods Refer to the literature on antegrade intramedullary nailing, focusing on the terms “pear-shaped socket” and “rotor socket”. 130 adult femoral trochanter samples were selected to analyze the relationship between the rotor and the greater trochanter. Twenty adult Chinese adult cadaver specimens were selected to observe the soft tissue attachment of the proximal femur. The data of piriformis, obturator muscle and obturator tendon were measured. Results (1) Without popliteal fossa is the standard intramedullary nail needle point. (2) 3.85% of the large trochanter in the sample completely does not block the rotor socket, 76.15% of the large rotor surrounds the rotor socket but does not block, 20.00% partially obstructs. (3) The average longitudinal and transverse diameters of piriformis were (6.74 ± 1.21) mm and (4.29 ± 1.37) mm, respectively. The average longitudinal and transverse diameters of the closed internal muscle were (6.36 ± 1.74) mm and 5.74 ± 1.61) mm. The average longitudinal and transverse diameters of the closed-cell outer muscles were (6.26 ± 1.13) mm and (4.57 ± 1.26) mm, respectively. (4) The percentage of the length of the greater trochanter to the greater trochanter was (57.9 ± 8.8)% and (43.8 ± 8.7)% respectively in the anterior and posterior margins of the piriformis, and (65.6 ± 7.3% and (52.6 ± 6.9)% respectively. Conclusions The so-called piriform fossa should be called a trochanter; because of the different relationships between the large trochanter and the rotor fossa, the entry point of the femoral nail is variable, the trochanter can not be considered as a universal needle point, and the quantitative data of the tendon Help optimize the surgical approach.