后内侧解剖钢板微创治疗胫骨远端骨折的解剖学研究

Minimally invasive application of posteromedial anatomical plate on treating the distal tibial fracture

目的通过解剖学研究评估后内解剖钢板(posteromedial anatomical plate,PmAP)微创治疗胫骨远端骨折的安全性及可行性。方法在12个冰冻成人尸体下肢标本上,模拟MIPO技术经后内侧入路固定胫骨远端骨折的手术操作。术中观察手术入路暴露的难易程度。术后主要考察手术切口与大隐静脉、隐神经关系,胫后、胫前神经血管束的完整性及其与钢板螺钉的接触关系。结果模拟手术操作顺利,暴露充分。手术切口与大隐静脉、隐神经主干在内踝上(7.37±1.65)cm(5.02～8.16 cm)处相交。胫后神经血管束位于钢板正后方,两者间有一厚层软组织垫相隔,未直接接触。仔细观察胫前、胫后神经血管束,未见损伤。结论应用MIPO技术经后内侧入路PmAP治疗胫骨远端骨折是一项安全、简便的手术技术。

Objective To explore the efficacy and safety of the posteromedial anatomical plate（PmAP） on treating the distal tibial fractures.Methods The simulated operation of minimally invasive plate osteosynthesis using PmAP was performed on six pairs frozen adult lower extremity specimens through posteromedial approach.The effects on operational field exposing was evaluated.Postoperatively,the relationship among the surgical incision and the GSV,SN was observed.The integrity of both anterior and posterior neurovascular bundles,the contact relation between the PmAP and the neurovascular bundles were focused on.Results The operation performed smoothly.Operational field exposing was sufficient.The dissection indicated that,the GSV,SN and surgical incision intersected at the point（7.37±1.65）cm（5.02～8.16 cm） above the medial malleolus,and there was no neurovascular damage,compression or entrapment caused by plates was found,as well,no direct contact between the implant and neurovascular bundle was found.Conclusions The study claims that the PmAP was simple and safe,for treating the distal tibial fractures through the posteromedial approach.