胫骨近端骨折“T”入路术式的解剖学研究

"T" operational approach in the treatment of proximal tibial fractures:anatomic study

目的为胫骨近端骨折"T"入路术式提供解剖学基础。方法 (1)灌注红色乳胶于4例成人下肢标本,对胫骨上段的血供和神经的分布进行研究,另在4例标本上摹拟手术。结果 (1)胫骨上段血供由骨骺干骺血管、滋养血管和骨膜血管系统构成;小腿上段神经由隐神经髌下支和胫前返神经分支分布;(2)"T"入路术式仅见膝降动脉的髌下支断裂,未见明显的神经分支,各层组织均有大量红色塑料溢出,切口均能充分暴露胫骨近端及关节面。结论 (1)胫骨上段和切口周围血供丰富;(2")T"入路术式对胫骨近段血运和神经无影响,且骨折端暴露充分、直视下手术操作安全方便。

Objective To provide anatomic basis for＂T＂operational approach in the treatment of proximal tibial fractures.Methods After perfusing with red plastics via the femoral artery of 4 adult leg specimens,the distributions of the vessels and the nerves around the upper tibia were described in details.While,＂T＂approaches were simulated on other 4 specimens and analyzed.Results（1）The blood supply of the superior tibia consisted of the epiphyses,epiphysial and metaphyseal arteries,the tibial nutrient artery and the periosteal arteries.The nerve distribution concerned with infrapatellar branch of saphenous nerve and anterior tibial recurrent nerve.（2）Only the infrapatellar branch of the descending genicular artery was broken during＂T＂approaches,but the nerve branches were not found.Red plastics could be seen in different tissues.＂T＂approaches could explore the proximal tibia and the surface of knee joint completely.Conclusions（1） There are abundant vessel networks around＂T＂approach area.（2）＂T＂approach is more valuable,for its sufficient surgical exposure,convenient and safe operative procedure.