On the inferior side of ischial spine is the lesser sciatic notch, which contains the obturator internus tendon. Sacrospinous ligament, the gemellus superior and the levator ani are inserted on the ischial spine. The neurovascular structures exit the pelvis along with the piriformis muscle through sciatic notch. The posterior superior iliac spine is adjacent to the sacroiliac joint and outer ilium. These vessels are the main source of bleeding and they can also be injured during surgical approach. The lumbosacral plexus as well as the gluteal vasculature lies in the vicinity. There is a strong buttress of bone extending from the iliosacral joint toward the acetabulum known as the sciatic buttress. The abdominal (anteriorly) and paraspinal (posteriorly) muscles are attached on the top . Along the inner portions, the iliacus and obturator internus and the pelvic floor musculatures are attached. The lower extremity hip motors are attached on the outer side. Various structures are attached on different sides of iliac crest. The iliac wing contains hematopoietic and osteogenic marrow elements and is the primary source of autogenous bone graft. Posteriorly it forms posterior iliac spine which is sagittally oriented. It begins anteriorly with a slight medial oblique orientation. Looking from above iliac wing appears S shaped. ![]() The external iliac fossa is marked with two semi-circular lines dividing it into three zones : This chapter mainly focuses on various aspects of surgical anatomy of acetabulum and biomechanics relevant to hip arthroscopy in detail. Lumbar plexus and its various nerve roots traverses the lesser and greater sciatic notches and are vulnerable to injury in portal placement and various other hip surgeries. An anomalous connection of these two arteries called circle of death or corona mortis should be identified and ligated properly as injury to this artery can lead to catastrophic results. The external iliac and internal iliac arteries lie in close relation to these columns. Discontinuity in any of these lines is considered fracture of anterior or posterior column. On radiographic view, anterior column is represented by iliopectineal line and posterior column by ilioischial line. ![]() These two limbs are considered anterior and posterior columns of acetabulum. The articular surface of acetabulum can be visualized as being supported between the limbs of an inverted “Y”. Acetabular and pelvic anatomy is complex yet important for any procedure to be done on hip joint. Hip arthroscopy requires a thorough knowledge of acetabular and pelvic anatomy.
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