Shenoy Pritom Mohan, Oh Hyung Keun, Choi Jun Young, Yoo Si Hoon, Han Seung Beom, Yoon Jung Ro, Koo Ja Sung, Nha Kyung Wook
Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Ilsan, South Korea.
Orthopedics. 2009 Jun;32(6):442. doi: 10.3928/01477447-20090511-29.
The popliteal artery is vulnerable to injury during surgeries performed around the knee joint. Pseudoaneurysm of the popliteal artery following a high tibial osteotomy is rare. Few case reports describe the development of this complication after a lateral closing wedge high tibial osteotomy. Our patient underwent an uneventful medial opening wedge high tibial osteotomy and autogenous bone grafting fixed with dual plating for medial osteoarthritis of the knee. The procedure was performed under tourniquet control, which was released only once after the wound closure. Postoperatively, the dressing was soaked, and a large volume of hemorrhagic collection was present in the suction drain. The patient experienced decreased sensation over the sole, which was successfully treated conservatively with medication. Other clinical parameters like motor function and distal pulses were normal. The patient was discharged after 2 weeks. Two days later, the patient presented with pain and numbness over the entire lower limb and a pulsatile swelling in the popliteal fossa. A femoral angiogram revealed a pseudoaneurysm arising from the popliteal artery just below the osteotomy site. Open vascular surgery with resection of the pseudoaneurysm and end-to-end anastomosis using contralateral saphenous vein interposition graft was performed. During the vascular surgery, a pinhead-sized tear was clearly identified on the anterior wall of the popliteal artery, which may have occurred while using the oscillating saw during opening wedge high tibial osteotomy. Careful placement of retractors around the osteotomy site during sawing and flexing the knee to displace the popliteal artery away are recommended to prevent this complication. To our knowledge, this is the first report of a popliteal artery pseudoaneurysm occurring after a medial opening wedge high tibial osteotomy.
在膝关节周围进行手术时，腘动脉易受损伤。高位胫骨截骨术后腘动脉假性动脉瘤较为罕见。仅有少数病例报告描述了外侧闭合楔形高位胫骨截骨术后出现这种并发症的情况。我们的患者因膝关节内侧骨关节炎接受了顺利的内侧开放楔形高位胫骨截骨术及自体骨移植，并采用双钢板固定。手术在止血带控制下进行，伤口缝合后仅松开过一次止血带。术后，敷料湿透，负压引流管中有大量血性积液。患者足底感觉减退，经药物保守治疗后成功治愈。其他临床参数如运动功能和远端脉搏均正常。患者术后2周出院。两天后，患者出现整个下肢疼痛和麻木，腘窝处有搏动性肿胀。股动脉血管造影显示在截骨部位下方的腘动脉处出现假性动脉瘤。遂进行了开放性血管手术，切除假性动脉瘤，并使用对侧大隐静脉间置移植进行端端吻合。在血管手术过程中，在腘动脉前壁清晰地发现了一个针头大小的撕裂口，这可能是在进行开放楔形高位胫骨截骨术使用摆动锯时发生的。建议在锯骨时在截骨部位周围小心放置牵开器，并屈曲膝关节使腘动脉移位，以预防这种并发症。据我们所知，这是首例关于内侧开放楔形高位胫骨截骨术后发生腘动脉假性动脉瘤的报告。
