胫骨近端内侧入路经皮微创钢板固定对胫前血管神经束的影响

Effects of proximal approach for anteromedial plate fixation of the tibia on the influence of anterior tibial neurovascular bundle

目的明确胫骨近端内侧解剖钢板螺钉固定对于下肢胫前血管神经束的安全区,避免在术中操作损伤胫前动脉及腓深神经。方法通过14例新鲜下肢标本行胫骨近端内侧入路微创钢板固定,观察螺钉固定位置并明确螺钉分布区域及对胫前血管神经束的影响,确定胫骨近端内侧钢板螺钉分布对于下肢的安全区及危险区。结果胫骨近端内侧入路钢板螺钉固定对胫前血管神经束的危险区域在胫骨平台下(17.7±3.3)cm,换算成百分比位置即胫骨平台内侧以下(44.7±8.2)%;双侧99%的可信区间为(42.4,47.8)%。结论胫骨近端内侧入路MIPPO技术创伤小、操作简单、效果优良,但是操作中钻孔及螺钉植入可能会对胫前血管神经束造成损伤,实验提出胫骨近端内侧钢板螺钉固定的安全区及危险区,根据实验结果指导操作,从而减少手术中的医源性损伤。

Objective To identify the exact anatomical tibial neurovascular bundle and measure the distance fromexternal and posterior tibia. Through clearing the medial proximal tibia anatomical plate and screw fixation distribu？tion region and examining the influence on the anterior neurovascular bundle, anatomic structures were determinedwhen placing plates from proximal to dista along the medial border of the tibia and avoiding arteriae tibialis anteriorand deep peroneal nerve injury. Methods 14 adult fresh specimens with lower extremity were performed. Plate andscrews were fixed by imitating operative manipulation to identify the relationships between the plate/ screws con？structs and the pedicle containing the deep peroneal nerve and the anterior tibial vessels （DPN/ ATV）. ResultsThe average tibia length was 39. 5 cm. The danger zone for the arteriae tibialis anterior and deep peroneal nerve av？eraged of the tibia length from the medial tibial plateau were （17.7±3.3） cm （99%CI： 42.4, 47.8）. Conclusion From this anatomy study, the danger zone could be determined as a percentage of tibia length, then the injurycould be avoided through the operation.