胫骨平台后外侧象限骨折手术入路的深层解剖及后外侧与后内侧比较

发布时间：2018-01-21 17:07

本文关键词： 胫骨平台骨折后内侧入路后外侧入路应用解剖　出处：《中国临床解剖学杂志》2015年05期 　论文类型：期刊论文

【摘要】：目的对比膝关节后内侧与后外侧入路所需显露的深层解剖结构,分析探讨其局限性与损伤重要结构的风险。方法 5个成人下肢尸体标本,解剖测量胫前动静脉穿过骨间膜上裂孔的位置和腓骨头对胫骨后外侧平台的遮挡面积比例;观察膝关节后外侧入路、后内侧入路需要显露的深层结构。结合解剖研究,临床应用20例,比较两种入路的优缺点。结果采用后外侧入路显露胫骨平台后外侧象限,主要有下列3个缺点:(1)胫前血管束向前穿过胫腓骨间膜上裂孔,三根血管纵向宽度在1 cm左右,其前穿点距离关节面和腓骨头最高点距离平均4.93 cm和3.77 cm;其上方伴行静脉,距二者的距离分别是4.41 cm和3.25 cm,影响切口的纵向显露;(2)腓骨头遮盖后外侧象限平均61.7%,阻挡向外的横向显露宽度;(3)显露后外侧关节面,需破坏部分后外侧角结构,包括乆肌肌腱复合体、韧带、关节囊等。结论显露孤立的胫骨平台后外侧象限骨折,采用膝关节后内侧入路,可能更为合适。
[Abstract]:Objective to compare the deep anatomical structures needed for the posterior medial and posterolateral approaches of the knee joint, and to analyze their limitations and the risk of injury of important structures. Methods five adult cadaveric cadavers were collected. The position of anterior tibial artery and vein through the superior interosseous fissure and the proportion of occlusion area of fibula head to the posterolateral tibial plateau were measured. The deep structures needed to be exposed by the posterolateral approach of the knee joint were observed. Combined with anatomical study, 20 cases were applied clinically. Results the posterior lateral quadrant of the tibial plateau was exposed by the posterior lateral approach, which had the following three disadvantages: 1) the anterior tibial vascular bundle passed forward through the superior tibial and fibula intermembrane fissure. The longitudinal width of the three vessels was about 1 cm, and the distance between the anterior puncture point and the highest point of the fibula head and the articular surface was 4.93 cm and 3.77 cm respectively. The distance between them was 4.41 cm and 3.25 cm respectively, which affected the longitudinal exposure of the incision. 2) the fibula head covers the posterolateral quadrant with an average of 61.7%, blocking the transverse exposure width; In order to expose the posterolateral articular surface, it is necessary to destroy part of the posterolateral horn structure, including muscle tendon complex, ligament, articular capsule, etc. Conclusion the isolated fracture of posterior lateral quadrant of tibial plateau is exposed. The posterior medial approach of the knee joint may be more appropriate.
【作者单位】：同济大学附属杨浦医院骨科;同济大学医学院人体解剖教研室;
【基金】：上海市科委基金医学引导类项目(14411971900)
【分类号】：R687.3;R322
【正文快照】： 随着CT在创伤骨科的广泛应用,胫骨平台后外侧冠状面骨折逐渐受到了临床的重视[1]。膝关节后侧存在诸多重要血管神经,而胫骨平台后外侧又受到腓骨头的遮挡,因此胫骨平台后外侧象限骨折的显露、复位与内固定较为困难。目前下列3个途径:(1)后正中入路(经乆窝腓肠肌内外侧头之间,

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