应用股骨内侧髁骨膜瓣治疗距骨巨大缺损的基础研究

Basic research on application of medial femoral condylar periosteal flap in the treatment of giant defect of talus

目的通过对股骨内侧髁的解剖测量,寻找最佳的骨膜瓣,为临床治疗距骨巨大缺损提供理论依据。方法在尸体标本上解剖膝降动脉及其分支,测量距骨各个关节面的面积及股骨内侧髁的解剖数据,设计带有膝降动脉终末支的骨膜瓣,适当修整骨膜瓣,将其置于距骨巨大缺损处,同时将膝降动脉端侧吻合于胫后动脉。观察以膝降动脉为蒂的股骨内侧髁骨膜瓣的解剖形态,寻找骨膜瓣与距骨缺损的最佳匹配方式。结果膝降动脉及其分支相对比较恒定,距骨滑车面积(11.36±1.72)cm2,距骨内踝关节面面积(2.04±1.72)cm2,外踝关节面面积(3.19±0.52)cm2,股骨内侧髁骨质丰富,所取带血管蒂的骨膜瓣足够修复距骨巨大缺损,且股骨内侧髁骨膜瓣与距骨的外形匹配度良好。结论通过基础解剖及模拟手术操作,带血管蒂的股骨内侧髁骨瓣可以用于治疗距骨巨大缺损,为临床距骨巨大缺损的治疗提供了新的理论基础。

Objective To find the best periosteal flap through anatomical measurement of the medial condyle of the femur, and to provide a theoretical basis for the clinical treatment of giant defects of the talus. Methods The knee descending artery and its branches were dissected from the corpse specimens. The anatomical data of the medial femora/ condyle and the area of each articular surface of the talus were measured. The periosteal flap with the terminal branch of the knee descending artery was designed. The periosteal flap was appropriately trimmed and placed at the great defect of the talus. At the same time, the end of knee-descending artery was anastomosed to the posterior tibial artery. The anatomical morphology of medial femoral condyles pedicled with knee descending artery were observed to find out the best match between periosteal flap and talus defect. Results The knee descending artery and its branches were relatively constant. The areas of the talus pulley, the talus medial ankle joint surface, the outer articular surface were （11.36±1.72）cm^2, （2.04±1.72）cm^2, （3.19±0.52）cm^2. The medial femur was rich in bone mass. The vascularized medial femoral condylar bone flap was enough to repair the huge defect of the talus. And the femoral medial condyle periosteal flap matched the shape of talus well. Conclusion The vaseularized medial femoral condylar bone flap can be used to treat giant defects of the talus through basic anatomy and simulated surgical procedures, providing a new theoretical basis for the treatment of giant defects of talus in the clinical.