| Background Since the development of the ilioinguinal approach by Letournel in1964for the treatment of acetabular fractures, this exposure has been well established.However,it involves exploration of the inguinal canal floor which (without complete repair) may result in groin hernias.Iit may result in inguinal herniation owing to the structure dissection of Inferior-area of myopectineal orifice when using the subinguinal approach. It has important significance for the prevention of femoral hernia to realize the structure of Inferior-area of myopectineal orifice from orthopedics viewpoint.Objectives1. To realize the structure of inferior-area of myopectineal orifice from orthopedics viewpoint by necroscopy refer to the technique of sub-ilioinguinal approach, and to offer the anatomy evidence for prevention of femoral hernia after operation of acetabulum fracture via this approach.2. To evaluate the feasibility of inferior-area of myopectineal orifice reconstructed with patch in subilioinguinal approach for treatment of acetabular fracture.Methods1. Twenty human adult cadavers were dissected in the Anatomy Department at Xinxiang Medical college. The anatomical structure of Inferior-area of myopectineal orifice, femoral sheath lacunar ligament and pecten pubis fascia that may show up with the use of sub-ilioinguinal approach were observed and documented.Analyzed the reason and prevention of femoral hernia via this approach combined with the theory of surgical hernia.2.From March2012to December2013,16patients with acetabular fracture were treated through the subilioinguinal approach for open reduction and internal fixtion. Among the total,6patients plus the inferior-area of myopectineal orifice reconstructed with patch. Operation time,blood loss,deep vein thrombosis, expand feeling of inguinal region and dominant femoral hernia were studied retrospectively between the pitch group and control group.Results1.The shape of Inferior-area of myopectineal orifice is similar to ladder-shaped and the length of four border was69.75±3.66mm,31.05±1.62mm,15.63±3.58mm, and38.75±2.52mm respectively.2. The connection between the anterior wall of femoral sheath and inguinal ligament as well the posterior wall to fascia iliopectinea is untight.3. The structure of lacunar ligament is integrated and distinct. The curved edge of lacunar ligament is easy to be separated from the link with medial wall of femoral sheath.4. Pectineus muscle fascia passes upwards and backwards to reach the pectineal ligament and obturator fascia, Its thickness is about2.23±1.35mm.5. All the patients were followed up for average of8.7(2to16)months.No infection,internal fixtion loosening,iatrogenic injury to the femoral nerve and vessel. One deep vein thrombosis and four expand feeling of inguinal region in control group.No significant difference of operation time and blood loss between two groups and no dominant femoral hernia occur in two groups.Conclusion1.The weak spaces of inferior-area of myopectineal orifice were the contingent positions of femoral hernia,and required protection and/or reconstruction.2. The size of Inferior-area of myopectineal orifice is constant approximately and to be restored using patch.3. The fascia on the surface of superior ramus of pubis is compact enough to be dissection and suture to avoid the damage of lacunar ligament.4. The repair of inferior-area of myopectineal orifice can optimally restore normal anatomy to avoid femoral hernia in subilioinguinal approach for treatment of acetabular fracture and not improve blood loss and complication of deep venous thrombosis... |
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