Anatomical research and clinical application of anterior approach for pelvic and acetabular fractures / 中华创伤杂志

ABSTRACT

Objective To perform an anatomical study on anterior approach to fractures of the pelvis and acetabulum in an attempt to testify feasibility of the approach.Methods Position and variation of anatomical structure of the hypogastric abdominal wall and pelvic cavity were observed in 10 cadaveric adults (20 sides).Based on the anatomical study,anterior approach to pelvic fractures (n =20)and acetabular fractures (n =15) were performed and clinical results were observed.Results Anterior pelvic incision revealed no splitting or exposure of the spermatic cord/round ligament of uterus.Vertical incision through the muscle layer of abdominal wall located at lateral rectus abdominis and medial initial segment of hypogastric arteries/veins.In clinical practice,the approach revealed the mean incision length of 10 cm (range,9-12 cm) and mean blood loss of (225.5 ± 30.5) ml (range,170-350 ml).No injuries to femoral nerve and sciatic nerve occurred and there was no deep vein thrombosis.Surgical incision healed primarily.Bone union were recorded at the 18-month follow-up (11-35 months).Conclusions Anterior pelvic approach stretches the operative field from pubic symphysis to anterior-lateral cacroiliac joint and quadrilateral surface,allowing full exposure of the fracture site.The approach has benefits of high safety,minor trauma,large exposure,and satisfactory results and hence deserves wide application in clinical settings.