跟骨内外侧、胫骨近端经皮穿针安全区解剖学研究

发布时间：2018-06-08 06:15

本文选题：安全区 + 血管神经　；参考：《河北医科大学》2009年硕士论文

【摘要】： 目的:划定国人跟骨内外侧、胫骨近端外固定针进针位置解剖学相对安全区,为临床医师手术中安全操作提供依据,减少临床并发症的发生。方法:选择4具防腐成年男性尸体,共8只下肢标本,各标本膝关节囊均完整未被破坏,踝部、足跟内、外侧深部结构尚未解剖,足部、膝部外观均无外伤、畸形等疾患。在每个标本足跟内侧:取跟骨最内下后点标记为“A”点,内踝最下点标记为“B”点,足舟骨结节标记为“C”点。(Fig.1)解剖分离出跟骨内侧神经(MCN)、足底外侧神经最后分支(MPLPN)、足底外侧神经(LPN)、足底内侧神经(MPN)和胫后动脉(PTA)或为足底外侧动脉(LPA)、足底内侧动脉(MPA)。测量AB、AC的距离(本文数据均以mm为单位,并精确到小数点后两位),分别测量AB、AC线上各神经血管结构与AB、AC线交点距A点的距离。计算各神经血管结构与AB、AC线交点距A点的距离分别占AB、AC线的百分比,确定跟骨内侧的相对安全区。在标本足跟外侧:取跟骨最外下后点标记为“D”点,外踝最下点标记为“E”点,解剖出跟骨外侧神经(LCN)、腓肠神经(SN)、小隐静脉(SSV)主干,测量DE的距离,分别测量DE线上各神经血管结构与DE线交点距D点的距离。计算各神经血管结构与DE线交点距D点的距离占DE线的百分比,确定跟骨外侧的相对安全区。再解剖胫骨近端,显露膝关节囊在胫骨近端各方向上的最低返折线。将胫骨平台假想为圆形表盘(正前方为0点或12点,正后方为6点),用时针点数的方向作为测量位置,依次测量、记录各点处膝关节囊滑膜层最低返折线(即关节囊纤维层附着线水平)距对应方位的胫骨平台外缘距离。统一以右膝顺时针为准,统计数据,确定膝关节囊在胫骨近端返折线的范围,进而确定胫骨近端经皮穿针安全区。结果:跟骨内侧:在AB线上跟骨内侧神经、足底外侧神经最后分支、足底外侧神经、足底内侧神经、胫后动脉与AB线交点距A点的距离占AB线距离的百分比分别为22%、50%、55%、64%、58%。即大部分重要神经血管结构位于AB线前上1/2。在AC线上跟骨内侧神经、足底外侧神经最后分支、足底外侧神经、足底内侧神经、足底外侧动脉、足底内侧动脉与AC线交点距A点的距离占AC线距离的百分比分别为14%、38%、48%、64%、41%、58%。即大部分重要神经血管结构位于AC线前上2/3。跟骨外侧:在DE线上跟骨外侧神经、腓肠神经、小隐静脉与DE线交点距D点的距离占DE线距离的百分比分别为20%、66%、62%。即大部分重要神经血管结构位于DE线前上2/5。膝关节囊:外侧最低返折点约位于5点附近,平均值为10.27mm,其95%可信区间为(8.18～12.36)。内侧最低返折点约位于10点附近,平均值为5.94mm,其95%可信区间为(5.25～7.6)。结论:在跟骨内侧,AB线后1/2 AC线后1/3的区域为经皮穿针相对安全区,靠后一些更安全。跟骨外侧,DE线后3/5为经皮穿针相对安全区。膝关节外侧关节囊最低返折点约位于5点附近,关节面下方12.36mm以下为经皮穿针相对安全区。膝关节内侧关节囊最低返折点位于10点附近,关节面下方7.6mm以下为经皮穿针相对安全区。
[Abstract]:Objective: to delimit the internal lateral lateral of the calcaneus of the Chinese and the relative safety area of the needle entry position of the proximal tibial external fixation needle, so as to provide the basis for the safety operation of the clinicians and reduce the incidence of clinical complications.
Methods: 4 adult male cadavers were selected and 8 lower limbs were intact. All the specimens of the knee joint were intact. The ankle, the heel and the deep lateral structure were not dissected. The appearance of the foot and knee were all without trauma and malformation. On the inside of the heel of each specimen, the most lower point of the heel was marked "A", and the lowest point of the medial malleolus was marked as the lower point of the medial malleolus. "B" point, the scaphoid tubercle is marked as "C" point. (Fig.1) dissection of the medial calcaneal nerve (MCN), the final branch of the lateral nerve (MPLPN), the lateral nerve of the foot (LPN), the medial plantar nerve (MPN) and the posterior tibial artery (PTA) or the medial plantar artery (LPA), and the medial plantar artery (MPA). The distance between the neurovascular structure of AB and the AC line and the distance from the AB and AC line to the A point was measured respectively. The distance between the nerve vessel structure and AB, the distance between the AC line intersection point and A point was AB, the percentage of the AC line, respectively, to determine the relative safety area of the medial calcaneus. At the lateral of the heel of the specimen, the two place of the calcaneus was marked as "the most out of calcaneus." D "point, the lowest point of the outer malleolus was marked as" E "point, dissected the lateral nerve (LCN), the gastrocnemius nerve (SN) and the trunk of the small saphenous vein (SSV), measured the distance between the DE and the DE line, and measured the distance between the intersection of the neurovascular structure and the DE line at the D point respectively. The distance between the node and D point of the nodal distance between the neurovascular and DE lines accounted for the percentage of the DE line and the calcaneus was determined. The relative safety zone on the lateral side of the tibia was dissected and the lowest back fold line in the proximal tibia of the knee was revealed. The tibial plateau was assumed to be a circular dial (0 or 12 points in front of the front, 6 in the rear), and the direction of the number of clockwise points was used as the measuring position, and the minimum back folding line at the knee capsule synovial layer at each point was recorded. The level of the attachment line of the fibrous layer of the joint capsule is distance from the outer edge of the tibial plateau of the corresponding azimuth. The statistical data is used to determine the range of the knee joint capsule in the proximal tibia, and then to determine the safety area of the proximal tibial puncture needle.
Results: the medial calcaneal nerve, the last branch of the lateral nerve, the lateral nerve of the foot, the medial plantar nerve, the medial plantar nerve, the distance from the A point distance between the posterior tibial artery and the AB line at the distance A, respectively, were 22%, 50%, 55%, 64%, and 58%., that is, most of the important neurovascular structures were located on the AC line and the medial calcaneus on the AC line at the front of the AB line. The percentage of the distance between the medial plantar nerve, the medial plantar nerve, the lateral artery of the foot, the distance between the medial plantar artery and the AC line distance from the A point was 14%, 38%, 48%, 64%, 41%, and 58%., the most important neurovascular structures were located at the lateral 2/3. calcaneus on the AC line, the lateral nerve of the calcaneus on the DE line, The percentage of the distance from the distance between the small saphenous vein and the DE line at the distance from the D point to the DE line was 20%, 66%, and 62%., the most important neurovascular structures were located in the upper 2/5. knee joint anterior to the DE line: the lateral lowest return point was about 5, the average value was 10.27mm, and the range of the 95% was (8.18 to 12.36). The lowest infolding point in the inner side was about to be located approximately. The average value is 5.94mm near 10 points, and the 95% confidence interval is (5.25 to 7.6).
Conclusion: in the medial part of the calcaneus, the area of 1/3 after the AB line 1/2 AC line is the relative safety area of the percutaneous needle puncture, which is more safe. On the lateral of the calcaneus, the 3/5 is the relative safety area of the percutaneous puncture. The lowest point of return of the lateral joint capsule of the knee is about 5, and the lower 12.36mm below the articular surface is the relative safety area of the percutaneous needle puncture. The medial clearance of the knee joint is in the medial part of the knee. The minimum recurrent point of the sac is located near the 10 point. Below the articular surface is 7.6mm relative safety zone.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R687.3;R322

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