Anatomic study of corona mortis artery by CT angiography combined with three-dimensional reconstruction technology
Yang Guoqing1, Rui Min2, Du Xingye2, Yin Xiaojun2, Zhang Yunqing2
1Affiliated Jiangyin Clinical College of Xuzhou Medical University, Jiangyin 214400, China; 2Department of Orthopaedics, Jiangyin People's Hospital, Jiangyin 214400, China
Abstract：Objective This study aimed to investigate the incidence, origin, course, and location of corona mortis (CMOR) artery to provide morphological basis for anterior pelvic approach surgery.Methods From June 2018 to June 2020, 112 patients (224 hemi-pelvises) underwent CTA, including 68 males and 44 females (aged 28-92 years). The incidence, origin, and course of CMOR artery were observed by three-dimensional reconstruction of CTA images. The incidence of the CMOR artery was compared between males and females and left and right hemi-pelvises. The diameter of the artery, the shortest distance from the upper edge of the superior pubic branch, and the distance from the middle point of the upper edge of the pubic symphysis were measured. The ratio of the vertical distance from the artery to the sagittal plane of the pubic symphysis and the vertical distance from the ipsilateral anterior superior iliac spine to the sagittal plane was calculated.Results Forty CMOR arteries were found in 224 hemi-pelvises 17.86％(40/224); among them, 19.12％(26/136) and 15.91％(14/88) were in males and females, respectively, and 16.07％(18/112) and 19.64％(22/112) were in the right and left sides, respectively. No significant difference was found (χ2=0.375, 0.487, all P values＞0.05). The diameter of the CMOR artery was (2.01±0.34) mm; the shortest distance between the CMOR artery and the upper edge of the superior pubic branch was (3.41±1.22) mm. The distance between the CMOR artery and the midpoint of superior pubic symphysis was (58.34±6.42) mm, which was (55.15±3.25)mm and (64.26±6.69) mm in males and females, respectively (t=-4.643, P＜0.01). The ratio of the vertical distance from the artery to the sagittal plane of the pubic symphysis to that from the ipsilateral superior iliac spine to the sagittal plane was 0.38±0.04, which was 0.36±0.03 and 0.42±0.04 in male and female, respectively; the difference was statistically significant (t=-4.897, P＜0.01).Conclusions The 3D reconstruction technology can clearly and accurately construct the 3D model of the CMOR artery and accurately measure its related anatomical parameters, which can help formulate a personalized surgical plan, guide the intraoperative approach, and reduce the risk of CMOR artery injury.
杨国庆, 芮敏, 独行业, 殷小军, 张云庆. CT血管造影结合三维重建技术对Corona Mortis动脉的解剖学研究[J]. 中华解剖与临床杂志, 2021, 26(1): 45-49.
Yang Guoqing, Rui Min, Du Xingye, Yin Xiaojun, Zhang Yunqing. Anatomic study of corona mortis artery by CT angiography combined with three-dimensional reconstruction technology. Chinese Journal of Anatomy and Clinics, 2021, 26(1): 45-49.
Rusu MC, Cergan R, Motoc AG, et al. Anatomical considerations on the corona mortis[J]. Surg Radiol Anat, 2010, 32(1): 17-24. DOI:10.1007/s00276-009-0534-7.
[2]
仇道迪, 周东生, 李连欣, 等. “死亡冠”血管的发生率及临床意义[J]. 中华骨科杂志, 2019, 39(5): 284-290. DOI:10.3760/cma.j.issn.0253-2352.2019.05.005.Chou DD, Zhou DS, Li LX, et al.The incidence and clinical significance of corona mortis vessel[J]. Chin J Orthop, 2019, 39(5): 284-290. DOI:10.3760/cma.j.issn.0253-2352.2019.05.005.
[3]
Al Talalwah W. A new concept and classification of corona mortis and its clinical significance[J]. Chin J Traumatol, 2016, 19(5): 251-254. DOI:10.1016/j.cjtee.2016.06.004.
[4]
Pellegrino A, Damiani GR, Marco S, et al. Corona mortis exposition during laparoscopic procedure for gynecological malignancies[J]. Updates Surg, 2014, 66(1): 65-68. DOI:10.1007/s13304-013-0245-9.
[5]
Ates M, Kinaci E, Kose E, et al. Corona mortis: in vivo anatomical knowledge and the risk of injury in totally extraperitoneal inguinal hernia repair[J]. Hernia, 2016, 20(5): 659-665. DOI:10.1007/s10029-015-1444-8.
[6]
朱仕文, 孙德江, 王满宜, 等. Corona mortis的解剖学研究[J]. 山东医药, 2010, 50(44): 28-29. DOI:10.3969/j.issn.1002-266X.2010.44.013.Zhu SW, Sun DJ, Wang MY, et al. Anatomical studies of Corona mortis[J]. Shandong Medical Journal, 2010, 50(44): 28-29. DOI:10.3969/j.issn.1002-266X.2010.44.013.
[7]
Kashyap S, Diwan Y, Mahajan S, et al. The majority of corona mortis are small calibre venous blood vessels: a cadaveric study of north indians[J]. Hip Pelvis, 2019, 31(1): 40-47. DOI:10.5371/hp.2019.31.1.40.
[8]
周禄科, 赵渝, 孙善全, 等. 国人corona mortis血管的应用解剖研究[J]. 中国实用外科杂志, 2012, 32(12): 1027-1030. Zhou LK, Zhao Y, Sun SQ, et al.Applied anatomical studying on corona mortis in Chinese[J]. Chinese Journal Practical Surgery, 2012, 32(12): 1027-1030.
[9]
Requarth JA, Miller PR. Aberrant obturator artery is a common arterial variant that may be a source of unidentified hemorrhage in pelvic fracture patients[J]. J Trauma, 2011, 70(2): 366-372. DOI:10.1097/TA.0b013e3182050613.
[10]
Karakurt L, Karaca I, Yilmaz E, et al. Corona mortis: incidence and location[J]. Arch Orthop Trauma Surg, 2002, 122(3): 163-164. DOI:10.1007/s004020100341.
[11]
Smith JC, Gregorius JC, Breazeale BH, et al. The corona mortis, a frequent vascular variant susceptible to blunt pelvic trauma: identification at routine multidetector CT[J]. J Vasc Interv Radiol, 2009, 20(4): 455-460. DOI:10.1016/j.jvir.2009.01.007.
[12]
吴清武, 岳军艳, 杨瑞民, 等. 多层螺旋CT三维重建技术在创伤性骨折中的应用[J]. 中国组织工程研究, 2012, 16(9): 1688-1691. DOI:10.3969/j.issn.1673-8225.2012.09.038.Wu QW, Yue JY, Yang RM, et al.Application of three-dimensional spiral CT reconstruction technology in traumatic fractures[J]. Chinese Journal of Tissue Engineering Research, 2012, 16(9): 1688-1691. DOI:10.3969/j.issn.1673-8225.2012.09.038.
[13]
Han Y, Liu P, Chen C, et al. A digital anatomical study of the corona mortis in females[J]. Minim Invasive Ther Allied Technol, 2017, 26(2): 111-118. DOI:10.1080/13645706.2016.1236818.
[14]
Steinberg EL, Ben-Tov T, Aviram G, et al. Corona mortis anastomosis: a three-dimensional computerized tomographic angiographic study[J]. Emerg Radiol, 2017, 24(5): 519-523. DOI:10.1007/s10140-017-1502-x.
[15]
Wada K, Goto T, Tezuka F, et al. Variations in the obturator artery around the obturator foramen assessed by three-dimensional computed tomographic angiography and prevention of vascular-related complications in rotational acetabular osteotomy[J]. Int Orthop, 2017, 41(1): 133-139. DOI:10.1007/s00264-016-3268-2.
[16]
赵辉, 张轩轩, 张丕军, 等. 基于CT血管造影三维重建的Corona Mortis动脉解剖学研究及其临床意义[J]. 中华创伤骨科杂志, 2013, 15(4): 303-307. DOI:10.3760/cma.j.issn.1671-7600.2013.04.006.Zhao H, Zhang XX, Zhang PJ, et al. The anatomical study of the corona mortis artery on three-dimensional computerized tomography angiography and its clinical significance[J].Chin J Orthop Trauma, 2013, 15(4): 303-307. DOI:10.3760/cma.j.issn.1671-7600.2013.04.006.
[17]
Sanna B, Henry BM, Vikse J, et al. The prevalence and morphology of the corona mortis (Crown of death): a meta-analysis with implications in abdominal wall and pelvic surgery[J]. Injury, 2018, 49(2): 302-308. DOI:10.1016/j.injury.2017.12.007.
[18]
欧艺, 杨洪昌, 陈戈, 等. 改良 Stoppa 入路[J]. 创伤外科杂志, 2016, 18(4): 252-255. DOI:10.3969/j.issn.1009-4237.2016.04.023.Ou Y, Yang HC, Chen G, et al. Modified Stoppa approach[J]. J Trauma Surg, 2016, 18(4): 252-255. DOI:10.3969/j.issn.1009-4237.2016.04.023.
[19]
Darmanis S, Lewis A, Mansoor A, et al. Corona mortis: an anatomical study with clinical implications in approaches to the pelvis and acetabulum[J]. Clin Anat, 2007, 20(4): 433-439. DOI:10.1002/ca.20390.
[20]
陈晓, 马坤龙, 徐海涛, 等. 改良Stoppa入路与髂腹股沟入路治疗骨盆、髋臼骨折的Meta分析[J]. 中国组织工程研究, 2017, 21(19): 3108-3116. DOI:10.3969/j.issn.2095-4344.2017.19.024.Chen X, Ma KL, Xu HT, et al. Modified Stoppa approach versus ilioinguinal approach for pelvic and/or acetabular fractures: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(19): 3108-3116. DOI:10.3969/j.issn.2095-4344.2017.19.024.
2021, Vol. 26 
