解剖学杂志2025，Vol.48Issue(2)：103-110,8.DOI:10.3969/j.issn.1001-1633.2025.02.002
髋臼骨折骨科手术机器人解剖学靶向手术路径探索及新发现
Exploration and new findings of anatomical targeted surgical path of orthopedic surgical robot for acetabular fractures
摘要
Abstract
Objective:To explore the anterior extraperitoneal anatomical targeted surgical approach for acetabular fractures and to meet the requirements for precise minimally invasive robotic-assisted orthopedic surgery.Methods:Fresh adult Chinese cadavers were used with arterial perfusion.Based on the clinical needs of internal fixation of acetabular fractures,five most common fracture sites of acetabulum were selected,including anterior column,anterior wall,acetabular roof,medial quadrilateral surface and greater ischial notch.The distribution and density of blood vessels with diameter≧2.0 mm were measured in the above areas.The shortest linear distance between blood vessels and bone was categorized as follows:GradeⅠ(extremely hazardous,0-5.0 mm),GradeⅡ(highly hazardous,5.0-10.0 mm),or GradeⅢ(moderately hazardous,10.0-20.0 mm).Venous and arterial distribution density≥10,8,6 vessels within a 30.0 mm radius was classified as Grade A(extremely hazardous),Grade B(highly hazardous),or Grade C(moderately hazardous).According to the above measurements,the vascular protection levels for 5 regions were drawn up.The extraperitoneal targeted minimally invasive surgical pathways were summarized to avoid important blood vessels.Results:Grade I vessels included the corona mortis,obturator artery and vein,femoral artery and vein,superior gluteal artery and vein,which required levelⅠprotection.GradeⅡvessels comprised iliolumbar artery and vein,internal iliac artery and vein and their branches,external iliac artery and vein,inferior gluteal artery and vein,which needed levelⅡprotection.GradeⅢvessels consisted of deep inferior epigastric artery and vein,umbilical artery and vein,testicular artery and vein,which called for levelⅢprotection.Grade A area was located at the greater sciatic notch.Grade B area was located at the obturator area of the superior pubic ramus,the acetabular roof and the medial quadrangle.Grade C area was located on the anterior wall.Blood vessels with a diameter≥5.0mm could cause rapid fatal hemorrhage after injury,including common iliac artery and vein,external iliac artery and vein,and internal iliac artery and vein.The vascular protection levels for the five regions were as follows:levelⅠA(superior gluteal artery and vein,obturator artery and vein,and coronary artery of death),level IB(Femoral artery and vein),levelⅡA(internal iliac artery and vein,external iliac artery and vein),levelⅡB(inferior gluteal artery and vein),levelⅢB(testicular artery and vein,uterine round ligament artery and vein,umbilical artery and vein).Five extraperitoneal targeted minimally invasive pathways for acetabular fractures were identified in superior pubic ramus,anterior wall(2 sites),acetabulum roof,and the greater sciatic notch area of arcuate line.Three newly discovered arteries,with 1.0-1.5 mm in diameter,which were not described in previous anatomical works and literature,were named as the pubic posterior trophic branch of the coronary artery of death,the psoas major branch and peritoneal branch of the superior gluteal artery,and the acetabular parietal trophic branch of the iliacus vessel.Conclusion:This study provides five targeted pathways for robotic-assisted orthopedic surgery to achieve precise and minimally invasive treatment of acetabular fractures,which can allow rapid access to the five targeted fracture sites of the acetabulum and reduce the iatrogenic damage to normal tissues in non-fracture areas.The three newly discovered vessels enrich anatomical understanding of acetabular vasculature and are of significant significance to avoid intraoperative vascular injury and bleeding.关键词
髋臼/血管/解剖学靶向通道/骨科手术机器人/智慧手术Key words
acetabulum/blood vessel/anatomical targeted pathway/orthopedic surgical robot/intelligent surgery分类
基础医学引用本文复制引用
肖靖炜,李明,王滇,黄燎原,刘建磊,徐方竹,刘玉新..髋臼骨折骨科手术机器人解剖学靶向手术路径探索及新发现[J].解剖学杂志,2025,48(2):103-110,8.基金项目
浙江省医药卫生科技计划项目(2018PY059) （2018PY059）
宁波市科技创新2025重大专项(2021Z128) （2021Z128）
