| Objective 1.To analyze the anatomical characteristics and significance of "corona mortis " vessels under Stoppa approach.2.To explore the prevention and treatment of primary and iatrogenic injury of "corona mortis" vessels.Methods From October 2015 to October 2020,60 patients with pelvic and acetabular fractures were treated by Stoppa approach,including 43 males and 17 females;The age ranged from 29 to 69 years old,with witch the average is(49.5±9.1)years old;There were 56 cases of unilateral pelvic and acetabular fractures and 4 cases of bilateral pelvic and acetabular fractures.Among the 60 patients,there were 8 cases of pelvic fractures,47 cases of acetabular fractures,and 4 cases of pelvic and acetabular fractures.According to Judet-letournel classification,acetabular fractures were classified as follows:anterior wall fracture in 1 case,anterior column fracture in 5 cases,anterior column plus anterior wall fracture in 5 cases,transverse fracture in 5 cases,anterior column with posterior half transverse fracture in 4 cases,T-shaped fracture in 7 cases and double column fracture in 24 cases.According to Tile classification,there were 1 case of type A,2 cases of type B1,1 case of type B2,3 cases of type B3,3 cases of type C1,1 case of type C2 and 1 case of type C3.The time from injury to operation was 4-18 days,with an average of(7.1 ±4.5)d。Stoppa approach was used for internal fixation in all patients whose could tolerate the operation.During the operation,the"corona mortis" vessels were carefully dissected and explored,and the incidence,number,arteriovenous type of the vessels were counted.The diameter of the vessels and the distance from the "corona mortis" vessels to the upper edge of the pubic symphysis were measured.At the same time,sutures were ligated or titanium clips were clamped to avoid injury.Results Among the 64 sides,56 sides had "corona mortis" vessels,and 8 sides had no "corona mortis" vessels.The incidence of "corona mortis”vessels was 89.1%(56/64).According to the type,10 cases were classified as arterial type,and the incidence was 17.8%(10/56);The incidence of venous type was 76.8%(43/56);There were 3 cases of arteriovenous mixed type,the incidence was 5.4%(3/56).According to gender,the incidence rate was 90.7%(39/43)in males and 88.2%(15/17)in females" The diameter of"death crown" was 1.6-4.5 mm,with an average of(3.1 ± 0.6)mm,the average distance from pubic symphysis was(59.8±7.1)mm;The diameter of the artery was 2.2～3.7mm,with an average of(2.9±0.4)mm,the average distance from pubic symphysis was(55.6 0 ± 4.3)mm。The average distance between the vessels of the "death crown" and the superior edge of the pubic symphysis was(5 8.2±7.4)mm。Conclusion The incidence of "corona mortis" vessels found in Stoppa approach is about 89.1%.The incidence is high.The diameter of the vessels is thick and close to the pubic symphysis.In the treatment of pelvic and acetabular fractures,we should pay attention to the primary injury and iatrogenic injury of "corona mortis" vessels,especially in pubic or acetabular fractures,the distance between the fracture block and pubic symphysis was(58.2±7.4)mm,the corresponding measures should be taken before operation to check whether there is "corona mortis" vessels damage,prevent vascular damage during operation,and actively and effectively deal with the damaged vessels,so as to avoid causing massive bleeding and irreparable results. |
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