Anatomy of the ilium for bone marrow aspiration: map of sectors and implication for safe trocar placement
Anatomy of the ilium for bone marrow aspiration: map of sectors and implication for safe trocar placement
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DOI：
10.1007/s00264-014-2353-7
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发表时间：
2014-12-01
影响因子：
2.7
通讯作者：
Hernigou, Philippe
中科院分区：
文献类型：
--
作者：
Hernigou, Jacques;Alves, Alexandra;Hernigou, Philippe
目的从定性的角度对人体髂骨的骨解剖结构进行了很好的描述;然而，很少有定量数据可以帮助外科医生从髂骨最厚部分的髂嵴进行骨髓抽吸。髂翼中松质骨的最小厚度（两个平台之间的横向厚度）是确保穿刺器安全放置在髂翼两个平台之间的重要因素。例如，用8号口径的（3.26 mm）套管针，可以认为如果髂骨翼的松质骨的横向厚度< 3 mm，则难以将套管针安全地插入两个工作台之间。其通过从沿髂嵴边缘沿着间隔的等距点到臀部中心绘制线来定义。这些扇区可以以相同的方式转移到任何患者。为了评估到达血管或神经结构的风险，在10具尸体的20个髂骨的不同部门引入410个套管针。厚度数据用于创建一个标测图，该标测图根据松质骨的厚度确定了可以使用直径为3 mm的套管针获取骨髓的部位。扇区2、3和6似乎更适合容纳直径为3 mm的穿刺器。扇区1、4和5包括髂嵴最薄部分的区域，其中一些区域比穿刺器直径更薄。扇形系统可靠地预测穿刺器放置的安全和不安全区域。在尸体上，解剖发现9个血管或神经病变，穿刺器插入第1、5和6区。结论使用扇形系统，穿刺器可以远离神经和血管结构，指向可能含有大量骨髓的区域。
Purpose The bony anatomy of the human ilium has been well described from a qualitative perspective; however, there are little quantitative data to help the surgeon to perform bone marrow aspiration from the iliac crest in the thickest part of the ilium. The minimum thickness of the spongiousus bone in an iliac wing (transverse thickness between the two tables) is an important factor in ensuring the safe placement of a trocar between the two tables of the iliac wing. For example, with an 8-gauge (3.26 mm) trocar, one can consider that if the transverse thickness of the spongiousus bone of the iliac wing is < 3 mm, it will be difficult to insert the trocar safely between the two tables.Methods For this study, we measured spongiousus bone thickness on 48 iliac wings to map the ilium in six sectors, which were defined by drawing lines from equidistant points spaced along the rim of the iliac crest to the centre of the hip. These sectors can be transposed in the same manner to any patient. To evaluate the risks to reach vascular or neurologic structures, 410 trocars were introduced in the different sectors of 20 iliac bones of ten cadavers.Results A map was constructed indicating the thickness of the spongiousus bone in each sector. The thickness data was used to create a map that identifies the sites where bone marrow can be obtained with a trocar of 3-mm diameter according to the thickness of the spongiousus bone. Sectors 2, 3 and 6 appear to be more favourable for accommodating a 3-mm diameter trocar. Sectors 1, 4 and 5 comprise the areas with the thinnest parts of the iliac crest, with some areas being thinner than the trocar diameter. The sector system reliably predicted safe and unsafe areas for trocar placement. In cadavers, dissection demonstrated nine vascular or neurologic lesions created when trocars were introduced into sectors 1, 5 and 6.Conclusion Using the sector system, trocars can be directed away from neural and vascular structures and towards zones that are likely to contain larger bone marrow stock.