膝关节后外侧倒“L”形径路放置支撑钢板时有效及安全性

Efficacy and safety of posterolateral knee inverted “L” shaped pathway when placing the supporting plate

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。由于有腘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。

BACKGROUND： Studies have shown that tibial plateau posterolateral fractures can be treated by posterolateral knee approach, however, there is no clear anatomical research to deeply evaluate and analyze this approach. OBJECTIVE： To evaluate the efficacy and safety of posterolateral knee inverted ＂L＂ shaped pathway in invIoving tibial plateau posterolateral fractures. METHODS： Eight fresh frozen adult corpses, 16 knees side, were all dissected using posterolateral inverted ＂L＂ shaped pathway. During the dissection, the exposure range was observed and important parameters of anatomical structure were measured. RESULTS AND CONCLUSION： The pathway may be fully exposed to the posterolateral aspect of tibial plateau and posterior cruciate ligament tibial insertions. The operations completed by out team did not create any obvious interference to superior tibi0fibular joint, fibular head and posterolateral corner structure. The exposed mean length of common peroneai nerve in incision was 56.48 mm, with a mean angle of 14.7° tilt towards the axis of the fibula. The mean distance between the neck of the fibular and fibular head tip was 31.26 mm, an average of 42.18 mm to the joint line. The mean distance between the opening of the interosseous membrane and the articular surface was 48.78 mm. The divergence of the fibular artery from the posterior tibial artery was an averageof 76.46 mm from articular surface. These results confirm that posterolateral inverted ＂L＂ shaped pathway met the requirements of anatomical reduction and buttress fixation for posterolateral tibial plateau fracture. Exposure of the common peroneal nerve can be minimized or even avoided by modifying the skin incision. Because the popliteal artery branches anterior tibial artery passed through interosseous membrane hole and peroneal artery and then separated from the posterior tibial artery, pathways dissection to distal deep area should be carried out carefully. Placement of a posterior buttressing plate carries a high vascular risk if the plate is implanted beneath these vessels.