Anatomical study on the placement of cross-screw guide needle of percutaneous channel fixation of the pubic symphysis diastasis and the relationship between the entry point and vital structures around the pelvis
Yang Demeng1, Dong Man2, Yi Runxin3, Han Jiayi4, Tian Zhen5, Qian Jialei6, Jia Yuxin3, Wu Zhenji5, Zhang Junkui6, Ma Jianjun7, Chen Zhiguo7
1Department of Emergency Trauma Surgery, PingXiang People's Hospital, Pingxiang 337000, China; 2Department of Medical Administration, the Third Affiliated Hospital of Xinxiang Medical University, Xinxiang 453003, China; 3School of Basic Medicine, Xinxiang Medical University, Xinxiang 453003, China; 4School of International Education, Xinxiang Medical University, Xinxiang 453003, China; 5the First Clinical College, Xinxiang Medical University, Xinxiang 453003, China; 6the Third Clinical College, Xinxiang Medical University, Xinxiang 453003, China; 7Laboratory of Gross Morphology of School of Basic Medicine, Xinxiang Medical University, Xinxiang 453003, China
Abstract：Objective The aim of this study was to explore the placement of cross-screw during percutaneous channel screw internal fixation for pubic symphysis diastasis and the distance relationship between the needle entry points and the vital structures around the pelvis. Methods Thirteen embalmed cadavers fixed with 10% formaldehyde were selected and divided into two groups according to gender: 9 in the male group, aged 48-70(57.2±7.8) years old, and 4 in the female group, aged 51-63(58.0±5.3) years old. Oblique and horizontal needle entry points were selected on each side of the pelvis, and the operation was simulated. The structures of male cadaveric specimens, including the spermatic cord, the corpus cavernosum, the midpoint of the penile root, the pubic tubercle on both sides, the midpoint of the top of the pubic symphysis, the ilioinguinal nerve, the genital branch of the genitofemoral nerve, the dorsal penile nerve, and the femoral artery and vein on both sides and the structures of female cadaveric specimens, including the uterine round ligament, the pubic tubercle on both sides, the midpoint of the top of the pubic symphysis, the ilioinguinal nerve, the genital branch of the genitofemoral nerve, the dorsal clitoral nerve, and the femoral artery and vein on both sides were anatomically exposed. Observation items included the following: (1) To measure and compare the length of the horizontal and oblique guide needles' insertion part, the angle between the horizontal and oblique guide needles, and the angles between the oblique needle and the three anatomical planes, namely, sagittal, coronal, and horizontal planes between the genders. (2) To measure the shortest distance between the entry point of the horizontal and oblique guide needles and the male anatomical landmark points and the female points on both sides, respectively, and compare the differences between genders in the shortest distances between the entry points of the horizontal and oblique guide needles and the midpoint of the pubic tuberosity, the top of the pubic symphysis, the ilioinguinal nerve, the genital branch of the genitofemoral nerve, and the ipsilateral femoral artery and vein. Results (1) The horizontal and oblique guide needle insertion lengths were (69.46±4.52) and (59.48±7.60) mm in females, respectively, which were longer than (57.70±7.70) and (50.76±10.19) mm in males, the angle between the horizontal and oblique guide needles was 30.69°±6.15°, which was smaller than 40.63°±10.30° in males, and the differences were statistically significant (t=4.02, 2.16, 2.52; all P values<0.05). The angle between the oblique guide needle and the sagittal plane was 79.08°±7.50° in females, which was greater than 58.07°±18.33° in males, and the angle with the horizontal plane was 29.76°±6.08°, which was smaller than 38.27°±10.05° in males, all with statistically significant differences (t=2.10, 2.21; all P values<0.05). The difference in the angle between the oblique needle and the coronal plane was not statistically significant between the genders (P>0.05). (2) In males, the horizontal and oblique needle entry points were closest to the spermatic cord, followed by the ipsilateral pubic tubercle, the ilioinguinal nerve, and the genital branch of the genitofemoral nerve, and farthest from the contralateral pubic tubercle. In females, the horizontal and oblique guide needle entry points were closest to the ilioinguinal nerve, followed by the ipsilateral pubic node, and farthest from the contralateral pubic tubercle. The distance between the horizontal and oblique guide needle entry points and the contralateral pubic tubercle was larger in females than in males, and the differences were statistically significant (t=2.62, 2.33; all P values<0.05). No statistically significant difference was observed between males and females in the shortest distance between the entry points of the horizontal and oblique guide needles and the ipsilateral pubic tuberosity, the midpoint of the top of the pubic symphysis, the ilioinguinal nerve, the genital branch of the genitofemoral nerve, and the ipsilateral femoral artery and vein (all P values>0.05). Conclusion The insertion lengths of horizontal guide needle and the angle between the oblique needle and the sagittal and coronal planes differ in genders during cross-screw internal fixation for pubic symphysis diastasis, and attention should be paid to avoiding damage to structures like the spermatic cord in males and the ilioinguinal nerve in females.
杨德猛, 董曼, 弋润欣, 韩佳易, 田振, 钱佳蕾, 贾豫昕, 仵振基, 张钧奎, 马建军, 陈志国. 耻骨联合分离经皮螺钉内固定术中交叉导针置入相关应用解剖学研究[J]. 中华解剖与临床杂志, 2023, 28(10): 640-645.
Yang Demeng, Dong Man, Yi Runxin, Han Jiayi, Tian Zhen, Qian Jialei, Jia Yuxin, Wu Zhenji, Zhang Junkui, Ma Jianjun, Chen Zhiguo. Anatomical study on the placement of cross-screw guide needle of percutaneous channel fixation of the pubic symphysis diastasis and the relationship between the entry point and vital structures around the pelvis. Chinese Journal of Anatomy and Clinics, 2023, 28(10): 640-645.
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2023, Vol. 28 
