A PRELIMINARY ANATOMICAL STUDY ON DESIGN OF CANNULATED SCREW CHANNELS FOR FIXATION OF SYMPHYSIS PUBIS DIASTASIS IN SMALL SAMPLES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MAKunlong ¹ ^# , ZHULei ² ^Δ ,  FANGYue ¹

1. Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;
2. Department of Anatomy, College of Basic and Forensic Medicine, Sichuan University;

Corresponding?author：

FANGYue, Email: fangyue1968@163.com

Keywords：

Symphysis pubis diastasis; Cannulated screws fixation; Channel

DOI：

10.7507/1002-1892.20140010

Video：

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Objective To design the channels of parallel screws and cross screws for fixation of symphysis pubis diastasis through a small sample anatomic study on pubic symphysis and its neighbor structures so as to provide anatomical basis for minimally invasive fixation of symphysis pubis diastasis. Methods Eight cadaveric pelvic specimens (6 men and 2 women) were transected along L₅ and the proximal 1/3 of bilateral thighs, with intact lumbar spines. The spermatic cord, womb round ligament, and corona mortis were dissected; the distance to the ipsilateral pubic tubercle was measured and subsequently the distance between pubic tubercles, the height of pubic symphysis, the diameter of outer edge of pubic tubercle, the thickness of pubic symphysis and 2 cm outside the pubic symphysis (upper, central, and lower 1/3 thickness of pubic symphysis) were measured to provide anatomical basis for the design of channels of parallel screws and cross screws. Results Parallel screw fixation: the entry point of first screw was on the outer edge of pubic tubercle, and its exit point was on the outer edge of contralateral pubic tubercle; a cannulated screw with a diameter of 4.5 mm or 6.5 mm can be suitable for this channel. The entry point of second screw was 20 mm outside the pubic symphysis and 23 mm beneath the pubic symphysis, and its exit point was symmetrical with entry point; a cannulated screw with a diameter of 4.5 mm can be appropriate for the second channel. The direction of two screws was perpendicular to the pubic symphysis. Cross screw fixation: the entry point of cross screws was on one side of the pubic tubercle, and its exit point was 20 mm outside the contralateral pubic symphysis and 23 mm beneath the contralateral pubic symphysis; two cannulated screws with a diameter of 4.5 mm can be chosen for cross screws channels. The direction of two cross screws was intersected with the horizontal line of two pubic tubercles at an angle of 25° respectively; besides, two cross screws formed an anteversion angle and retroversion angle of 5-10° with pubic body plane, respectively. Conclusion The channels of parallel screws and cross screws are feasible for fixation of symphysis pubis diastasis by analyzing the anatomical data of the pubic symphysis and its neighbor structures, but further biomechanical research is need to confirm the stability of two fixation methods.

Citation： MAKunlong, ZHULei, FANGYue. A PRELIMINARY ANATOMICAL STUDY ON DESIGN OF CANNULATED SCREW CHANNELS FOR FIXATION OF SYMPHYSIS PUBIS DIASTASIS IN SMALL SAMPLES. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(1): 43-46. doi: 10.7507/1002-1892.20140010 Copy

1.	Pohlemann T,Boseh U,G?nsslen A,et al.The Hannover experience in management of pelvic fractures.Clin Orthop Relat Res,1994,(305):69-80.
2.	周建明,章銀燦,石高才,等.恥骨聯合分離的治療策略.中國骨傷,2008,21(1):58-59.
3.	Mu WD,Wang H,Zhou DS,et al.Computer navigated percutaneous screw fixation for traumatic pubic symphysis diastasis of unstable pevic ring injuries.Chin Med J (Engl),2009,122(14):1699-1703.
4.	Chen L,Zhang G,Song D,et al.A comparison of percutaneous reduction and screw fixation versus open reduction and plate fixation of traumatic symphysis pubis diastasis.Arch Orthop Trauma Surg,2012,132(2):265-270.
5.	石成弟,郭曉山,胡煒,等.經皮空心釘固定治療創傷性恥骨聯合分離.中華骨科雜志,2011,31(11):1218-1222.
6.	郭曉山,池永龍.經皮閉合內固定治療骨盆環損傷.中華外科雜志,2006,44(4):260-263.
7.	唐廣滿,水小龍,戴志兵,等.空心拉力螺釘與重建鋼板治療恥骨聯合分離的療效比較.創傷外科雜志,2011,13(6):515-519.
8.	黃高,王金華,張軍,等.經皮復位螺釘固定與切開復位內固定治療恥骨聯合分離的療效比較.創傷外科雜志,2013,15(1):36-40.
9.	余可和,洪建軍,陳臨煒,等.空心螺釘與重建鋼板固定恥骨聯合分離的生物力學穩定性比較.醫用生物力學,2010,25(6):475-478.
10.	Cano-Luis P,Giráldez-Sanchez MA,Martínez-Reina J,et al.Biomechanical analysis of a new minimally invasive system for osteosynthesis of pubis symphysis disruption.Injury,2012,43 Suppl 2:S20-S27.
11.	Kacra BK,Arazi M,Cicekcibasi AE,et al.Modified medial Stoppa approach for acetabular fractures:an anatomic study.J Trauma,2011,71(5):1340-1344.
12.	Berbero?lu M,Uz A,Ozmen MM,et al.Corona mortis:an anatomic study in seven cadavers and an endoscopic study in 28 patients.Surg Endosc,2001,15(1):72-75.
13.	Okcu G,Erkan S,Yercan HS,et al.The incidence and location of corona mortis:a study on 75 cadavers.Acta Orthop Scand,2004,75(1):53-55.
14.	Drewes PG,Marinis SI,Schaffer JI,et al.Vascular anatomy over the superior pubic rami in female cadavers.Am J Obstet Gynecol,2005,193(6):2165-2168.
15.	Darmanis S,Lewis A,Mansoor A,et al.Corona mortis:an anatomical study with clinical implications in approaches to the pelvis and acetabulum.Clin Anat,2007,20(4):433-439.

1. Pohlemann T,Boseh U,G?nsslen A,et al.The Hannover experience in management of pelvic fractures.Clin Orthop Relat Res,1994,(305):69-80.
2. 周建明,章銀燦,石高才,等.恥骨聯合分離的治療策略.中國骨傷,2008,21(1):58-59.
3. Mu WD,Wang H,Zhou DS,et al.Computer navigated percutaneous screw fixation for traumatic pubic symphysis diastasis of unstable pevic ring injuries.Chin Med J (Engl),2009,122(14):1699-1703.
4. Chen L,Zhang G,Song D,et al.A comparison of percutaneous reduction and screw fixation versus open reduction and plate fixation of traumatic symphysis pubis diastasis.Arch Orthop Trauma Surg,2012,132(2):265-270.
5. 石成弟,郭曉山,胡煒,等.經皮空心釘固定治療創傷性恥骨聯合分離.中華骨科雜志,2011,31(11):1218-1222.
6. 郭曉山,池永龍.經皮閉合內固定治療骨盆環損傷.中華外科雜志,2006,44(4):260-263.
7. 唐廣滿,水小龍,戴志兵,等.空心拉力螺釘與重建鋼板治療恥骨聯合分離的療效比較.創傷外科雜志,2011,13(6):515-519.
8. 黃高,王金華,張軍,等.經皮復位螺釘固定與切開復位內固定治療恥骨聯合分離的療效比較.創傷外科雜志,2013,15(1):36-40.
9. 余可和,洪建軍,陳臨煒,等.空心螺釘與重建鋼板固定恥骨聯合分離的生物力學穩定性比較.醫用生物力學,2010,25(6):475-478.
10. Cano-Luis P,Giráldez-Sanchez MA,Martínez-Reina J,et al.Biomechanical analysis of a new minimally invasive system for osteosynthesis of pubis symphysis disruption.Injury,2012,43 Suppl 2:S20-S27.
11. Kacra BK,Arazi M,Cicekcibasi AE,et al.Modified medial Stoppa approach for acetabular fractures:an anatomic study.J Trauma,2011,71(5):1340-1344.
12. Berbero?lu M,Uz A,Ozmen MM,et al.Corona mortis:an anatomic study in seven cadavers and an endoscopic study in 28 patients.Surg Endosc,2001,15(1):72-75.
13. Okcu G,Erkan S,Yercan HS,et al.The incidence and location of corona mortis:a study on 75 cadavers.Acta Orthop Scand,2004,75(1):53-55.
14. Drewes PG,Marinis SI,Schaffer JI,et al.Vascular anatomy over the superior pubic rami in female cadavers.Am J Obstet Gynecol,2005,193(6):2165-2168.
15. Darmanis S,Lewis A,Mansoor A,et al.Corona mortis:an anatomical study with clinical implications in approaches to the pelvis and acetabulum.Clin Anat,2007,20(4):433-439.

Chinese Journal of Reparative and Reconstructive Surgery

A PRELIMINARY ANATOMICAL STUDY ON DESIGN OF CANNULATED SCREW CHANNELS FOR FIXATION OF SYMPHYSIS PUBIS DIASTASIS IN SMALL SAMPLES

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