Anatomy Of The Main Nutrient Foramen Of Ilium And Its Clinical Significance

Objective:1.To analyze the anatomical position of the main nutrient foramen located on the inner side of the iliac bone at the outer side of the sacroiliac joint,indirectly study the diameter and travelling of blood vessels in the nutrient foramen,and provide anatomical parameters for the placement of fixators in clinical pelvic fracture surgery.2.To discuss the prevention and treatment of primary and iatrogenic injuries to the main nutrient foramen.Method:1.Thirty cases of unilateral dry hip bones,15 cases of the left and 15 cases of the right,were divided into two groups to calculate the shape,size,and position of the main nutrient foramen.2.Six pelvic cadaveric specimens,three males and three females,were selected to expose the main nutrient foramen through layer by layer dissection.And estimate the position of the main nutrient foramen.3.One hundred adult pelvic CT three-dimensional reconstruction images,including 50 males and 50 females,were divided into four groups according to gender and,and the shape and position of the main nutrient foramen on the CT three-dimensional reconstruction images were statistically analyzed.4.In clinical practice,patients with pelvic or acetabular fractures who choose to undergo the Stoppa approach should undergo intraoperative electrocoagulation or bone wax filling of the main nutrient foramen,record and calculate the amount of bleeding,and compare the perioperative bleeding and prognosis of similar surgeries over the years.Results:Most of the internal surfaces of the pelvic iliac bone have main nutrient foramen,and most of them are oval.Among the dry specimens,1 pelvic specimen has no main nutrient foramen in the areas.There are 3 round main nutrient foramen and26 oval main nutrient foramen.The size of the left main nutrient foramen is about 1.4± 0.3 mm,and the size of the right main nutrient foramen is 1.4 ± 0.3 mm.The left main nutrient foramen are 13.8 ± 3.9 mm from the outside of the sacroiliac joint,14.6± 3.6 mm from the true pelvic margin,14.9 ± 4.9 mm from the outside of the sacroiliac joint,and 14.1 ± 4.4 mm from the true pelvic margin.In 100 cases of pelvis CT three-dimensional reconstruction images,12 unilateral iliac internal surfaces have no nutrient foramen in the outside of the sacroiliac joint,and the other two sides have main nutrient foramen,of which there are 13 circular main nutrient foramen,and 175 are oval.The distance from the left main nutrient foramen to the outside of the sacroiliac joint is 16.3 ± 3.8 mm,and the distance from the pelvic margin of the talus is 13.5 ± 3.8 mm;The right main nutrient foramen are 17.8 ± 3.1 mm from the outside of the sacroiliac joint and 13.6 ± 2.9 mm from the true pelvic margin.The distance from the left main nutrient foramen to the outside of the sacroiliac joint is 15.3 ± 3.0mm,and to the true pelvic margin is 15.2 ± 3.9 mm;The right main nutrient foramen are 15.5 ± 3.3 mm from the outside of the sacroiliac joint and 14.3 ± 5.4 mm from the true pelvic margin.There was no significant difference between the measured data of pelvic dry specimen and the partial data measured by CT three-dimensional reconstruction(P>0.05).Combined with the two measurements,the main nutrient foramen were located 16.1 ± 3.4mm from the sacroiliac joint and 14.1 ± 4.1 mm from the true pelvic margin.There was no significant difference in the size and location of the main nutrient foramen between the left and right sides of the same sex and between the male and female(P>0.05).Conclusion:The incidence of the main nutrient foramen on the outside of the sacroiliac joint is about 94.3%,which is extremely high.It is 16.1 ± 3.4mm on the outside of the sacroiliac joint and 14.1 ± 4.1mm above the true pelvic edge.There are nutrient vessels from the iliolumbar artery in the inner course,which are thick and bleed more when injured.When treating pelvic and acetabular fractures in clinical practice,you should be alert to the primary injury and iatrogenic injury of the foramen,especially when the bone fracture line is near the sacroiliac joint.Before surgery,auxiliary examinations are conducted to determine whether there is damage to the hole.During surgery,prevention of damage to the hole is necessary,and timely and effective treatment is given to the damaged main nutrient hole to avoid serious consequences caused by excessive blood loss.