Summary
Most direct vascular trauma occurring during hip surgery results from injury to pelvic vascular structures which are not visible during the procedures of reaming, drilling holes or the fixation of screws. In this study, 5 pelves of fresh cadavers were injected with a radiopaque mixture and were visualised with a scanner according to 5 predetermined sections. Bone depth of the acetabulum was measured in each section. A calculation was made describing the minimal distance separating the inner cortex from the principal pelvic vessels. After an anatomic dissection of each pelvis, the relationship between the vessels and screws of the fixation cup, implanted identically on the quadranted acetabulum, was observed.
The screws placed in the anterior and inferior quadrants and the center of the acetabulum endangered the external iliac v. and a. and the obturator pedicle. The depth of the periacetabular bone was greater in the superior and posterior quadrants. The inferior gluteal, pudendal and superior gluteal aa. were more than ten mm from the posterior wall. Conversely, the external iliac and obturator pedicles came in contact with the osseous surface on which they lay. A projection of the vessels on the acetabulum was made, and the reproducible character of the acetabular-quadrant system was verified. The superior quadrant offers all the characteristics of a vascular safe zone. A knowledge of these anatomic relationships explain vascular trauma in pelvic fractures and helps to prevent vascular injury in hip surgery.
Résumé
Les traumatismes vasculaires directs survenant au cours de la chirurgie de hanche découlent pour la plupart du fraisage, du forage d'un trou ou de la pose d'une vis d'ancrage. Ces gestes se font à l'aveugle vis-à-vis des vaisseaux pelviens. Cinq pelvis injectés étaient étudiés au scanner suivant 5 plans de coupe. Nous avons mesuré les épaisseurs osseuses des acétabulums, ainsi que la distance qui séparait la corticale interne des principaux vaisseaux pelviens. Après dissection de chaque pelvis, nous avons noté les relations qui existaient entre les vaisseaux et des vis de fixation de cupule implantées de manière identique dans les acétabulums quadrillés. Les vis des quadrants antérieurs, inférieurs et du centre de l'acétabulum, mettaient en danger la v. et l'a. iliaques externes, le pédicule obturateur. L'épaisseur de l'os périacétabulaire était la plus importante dans les quadrants supérieur et postérieur. Les aa. glutéale inférieure, pudendale et glutéale supérieure restaient éloignées de plus de 10 mm de la paroi postérieure. A l'inverse, les pédicules iliaque externe et obturateur entraient en contact avec la surface osseuse sur laquelle ils étaient fixés. Nous avons établi une projection des vaisseaux sur l'acétabulum et vérifié le caractère reproductible du quadrillage acétabulaire. Le quadrant supérieur offre toutes les caractéristiques d'une zone de sécurité vasculaire. La connaissance de ces rapports anatomiques explique les lésions vasculaires associées aux traumatismes du bassin et participe à la prévention des accidents vasculaires au cours de la chirurgie de hanche
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Feugier, P., Fessy, M.H., Béjui, J. et al. Acetabular anatomy and the relationship with pelvic vascular structures implications in hip surgery. Surg Radiol Anat 19, 85–90 (1997). https://doi.org/10.1007/BF01628131
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DOI: https://doi.org/10.1007/BF01628131