Abstract：
BACKGROUND: In this study, we investigated the area that can be addressed with an approach in which the skin incision is made directly above the dorsal column with Thiel cadaveric specimens.
METHODS: Six Thiel cadaveric specimens were prepared. A skin incision was made directly above the dorsal column. The accessible proximal end from the proximal part of the greater sciatic notch to the gluteal ridge and the accessible distal end of the ischium were marked with a flat chisel. A molded 8-hole reconstruction plate was placed from the base of the ischium toward the gluteal ridge and fixed with 3 screws proximally and 2 screws distally. The length of the skin incision and the distance from each reference point on the bone to the reachable markings were assessed after the muscles were removed.
RESULTS: Mean skin incision length was 9.3 ± 0.7 (range, 8.0-10.0) cm. In 3 of 6 cases, proximal screws were inserted through different spaces between muscle fibers. In all cases, we were able to reach at least the greater sciatic notch, the gluteal ridge at the level of superior border of the acetabulum, and the base of the ischial tuberosity. In all cases, an 8-hole plate could be placed from the gluteal ridge to the base of the ischium. There were no superior gluteal artery or sciatic nerve injuries in any of the cases.
CONCLUSIONS: We anatomically investigated the area that can be addressed with an approach in which the skin incision was made directly above the dorsal column. In all cases, we were able to access the areas needed to reduce the fracture and place the plates necessary to stabilize the fracture through a 9.3 ± 0.7 cm skin incision. This approach can be a useful minimally invasive posterior approach for acetabular fractures.
METHODS: Six Thiel cadaveric specimens were prepared. A skin incision was made directly above the dorsal column. The accessible proximal end from the proximal part of the greater sciatic notch to the gluteal ridge and the accessible distal end of the ischium were marked with a flat chisel. A molded 8-hole reconstruction plate was placed from the base of the ischium toward the gluteal ridge and fixed with 3 screws proximally and 2 screws distally. The length of the skin incision and the distance from each reference point on the bone to the reachable markings were assessed after the muscles were removed.
RESULTS: Mean skin incision length was 9.3 ± 0.7 (range, 8.0-10.0) cm. In 3 of 6 cases, proximal screws were inserted through different spaces between muscle fibers. In all cases, we were able to reach at least the greater sciatic notch, the gluteal ridge at the level of superior border of the acetabulum, and the base of the ischial tuberosity. In all cases, an 8-hole plate could be placed from the gluteal ridge to the base of the ischium. There were no superior gluteal artery or sciatic nerve injuries in any of the cases.
CONCLUSIONS: We anatomically investigated the area that can be addressed with an approach in which the skin incision was made directly above the dorsal column. In all cases, we were able to access the areas needed to reduce the fracture and place the plates necessary to stabilize the fracture through a 9.3 ± 0.7 cm skin incision. This approach can be a useful minimally invasive posterior approach for acetabular fractures.
摘要：
背景：在这项研究中，我们调查了可以通过Thiel尸体标本在背柱正上方进行皮肤切口的方法解决的区域。
方法:制备6个Thiel尸体标本。直接在背柱上方进行皮肤切口。从大坐骨凹口的近端到臀脊的可接近的近端和坐骨的可接近的远端用扁平凿子标记。将模制的8孔重建板从坐骨的底部朝向臀脊放置，并用近端3个螺钉和远端2个螺钉固定。在移除肌肉后评估皮肤切口的长度和从骨骼上的每个参考点到可到达标记的距离。
结果：平均皮肤切口长度为9.3±0.7（范围，8.0-10.0)厘米。在6个病例中的3个中，通过肌纤维之间的不同间隙插入近端螺钉.在所有情况下,我们至少能够达到坐骨神经更大的缺口，髋臼上边界水平的臀沟，和坐骨结节的底部。在所有情况下,可以从臀脊到坐骨底部放置一个8孔的板。所有病例均无臀上动脉或坐骨神经损伤。
结论：我们从解剖学角度研究了在背柱正上方进行皮肤切口的方法可以解决的区域。在所有情况下,我们能够通过9.3±0.7cm的皮肤切口进入骨折复位所需的区域,并放置稳定骨折所需的钢板.这种方法可以是髋臼骨折的一种有用的微创后入路。
方法:制备6个Thiel尸体标本。直接在背柱上方进行皮肤切口。从大坐骨凹口的近端到臀脊的可接近的近端和坐骨的可接近的远端用扁平凿子标记。将模制的8孔重建板从坐骨的底部朝向臀脊放置，并用近端3个螺钉和远端2个螺钉固定。在移除肌肉后评估皮肤切口的长度和从骨骼上的每个参考点到可到达标记的距离。
结果：平均皮肤切口长度为9.3±0.7（范围，8.0-10.0)厘米。在6个病例中的3个中，通过肌纤维之间的不同间隙插入近端螺钉.在所有情况下,我们至少能够达到坐骨神经更大的缺口，髋臼上边界水平的臀沟，和坐骨结节的底部。在所有情况下,可以从臀脊到坐骨底部放置一个8孔的板。所有病例均无臀上动脉或坐骨神经损伤。
结论：我们从解剖学角度研究了在背柱正上方进行皮肤切口的方法可以解决的区域。在所有情况下,我们能够通过9.3±0.7cm的皮肤切口进入骨折复位所需的区域,并放置稳定骨折所需的钢板.这种方法可以是髋臼骨折的一种有用的微创后入路。
