膝关节后外侧倒“L”形径路放置支撑钢板时有效及安全性

发布时间：2018-03-06 14:13

本文选题：组织工程　切入点：胫骨　出处：《中国组织工程研究》2015年53期 　论文类型：期刊论文

【摘要】：背景:有研究表明胫骨平台后外侧骨折可以通过膝关节后外侧入路进行处理,但尚无明确的解剖学研究对此入路进行深入的评估和分析。目的:评估膝关节后外侧倒"L"形径路在累及胫骨平台后外侧骨折治疗中的安全性及有效性。方法:新鲜冰冻成人尸体8具,双膝16侧。均行后外侧倒"L"形径路解剖。解剖中观察显露范围,并测量重要解剖结构参数。结果与结论:该径路可以充分暴露平台后外侧、后交叉韧带胫骨止点等。作者团队在操作上对上胫腓关节、腓骨头及膝关节后外侧角结构无明显干扰。腓总神经在切口内暴露长度平均为56.48 mm,与腓骨轴成平均14.7°倾斜。其绕腓骨颈处距腓骨头尖平均为31.26 mm,距关节线的平均为42.18 mm。骨间膜裂孔距关节面距离平均为48.78 mm。腓动脉自胫后动脉发出点距关节面平均为76.46 mm。结果证实,经解剖学证实后外侧倒"L"形径路能够满足后外侧骨折解剖复位支撑固定的需要,通过改良皮肤切口可以减少甚至避免对腓总神经暴露。由于有乆动脉分支胫前动脉穿越骨间膜裂孔及腓动脉自胫后动脉分出,径路向远侧深部剥离时需小心进行,放置支撑钢板时可能穿越血管下方,有一定风险。
[Abstract]:Background: studies have shown that fractures of the posterolateral tibial plateau can be managed through the posterolateral approach of the knee joint. However, there is no definite anatomical study to evaluate and analyze this approach. Objective: to evaluate the safety and efficacy of posterolateral "L" approach in the treatment of posterolateral tibial plateau fractures. 8 fresh frozen adult bodies, 16 knees were dissected with the anterolateral "L" approach. The exposed area was observed and important anatomical parameters were measured. Results and conclusions: the posterior lateral of the platform can be fully exposed by this approach. Posterior cruciate ligament tibial insertion and so on. The length of the common peroneal nerve exposed in the incision was 56.48 mm, which was inclined to the fibula axis on average 14.7 掳. The average length of the peroneal nerve around the fibula neck was 31.26 mm from the fibula head tip and the average line of the talus joint. The distance from the interosseous membrane fissure to the articular surface was 48.78 mm. the average distance from the posterior tibial artery to the articular surface of the peroneal artery was 76.46 mm. Anatomically proved that the retrograde "L" path of posterolateral fracture can meet the need of anatomical reduction and fixation of posterolateral fracture. Exposure to the common peroneal nerve can be reduced or even avoided through a modified skin incision. Since there are some branches of the anterior tibial artery that pass through the interosseous hiatus and the peroneal artery is separated from the posterior tibial artery, the path to the distal depth should be carefully dissected. Placement of the support plate may be through the blood vessel below, there is a certain risk.
【作者单位】：江苏省海门市人民医院骨科;上海交通大学附属第六人民医院骨科;
【基金】：上海同济大学解剖学教研室对实验的的支持和专业指导
【分类号】：R687;R322.7

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