Marchant D C, Rimmington D P, Nusem I, Crawford R W
The Prince Charles Hospital, Brisbane, Queensland, Australia.
Comput Aided Surg. 2004;9(6):257-60. doi: 10.3109/10929080500163547.
A number of navigation systems used for total knee replacement surgery currently require the insertion of a distal femoral reference sensor pin, which is placed anterior to posterior just superior to the level of the knee joint. There is potential for the posterior neurovascular bundle to be damaged during the insertion of this sensor device. The aim of this cadaveric study was to identify the structures at risk during insertion of the distal femoral sensor, and determine whether a safe zone for insertion could be identified. Sixteen cadaveric lower limbs (8 pairs) were studied. In each knee Steinman pins were passed from anterior to posterior, 5 cm proximal to the level of the femoral articular cartilage, directly AP and angled at 30 degrees passing medially or laterally. All pins that were passed directly from anterior to posterior and from lateral to medial passed within 5 mm of a major neurovascular structure, while 62.5% of pins passing from medial to lateral passed within 5 mm of a major neurovascular structure. The popliteal vessels and the sciatic nerve are at risk of injury from a navigation pin or drill placed in the distal femur during knee navigation. Caution should be exercised in passing these pins and alternate methods of fixing femoral sensors should be considered.
目前，许多用于全膝关节置换手术的导航系统需要插入一个股骨远端参考传感器针，该针从前向后插入，刚好位于膝关节水平上方。在插入该传感器装置的过程中，后神经血管束有受损的风险。本尸体研究的目的是确定在插入股骨远端传感器时存在风险的结构，并确定是否可以确定一个安全的插入区域。对16个尸体下肢（8对）进行了研究。在每个膝关节中，斯氏针从前向后穿过，在股骨关节软骨水平近端5厘米处，直接从前向后，并以30度角向内侧或外侧倾斜。所有直接从前向后和从外侧向内侧穿过的针都在主要神经血管结构的5毫米范围内穿过，而从内侧向外侧穿过的针中有62.5%在主要神经血管结构的5毫米范围内穿过。在膝关节导航过程中，腘血管和坐骨神经有被放置在股骨远端的导航针或钻头损伤的风险。在插入这些针时应谨慎，并应考虑其他固定股骨传感器的方法。
