Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea.
Am J Sports Med. 2010 Apr;38(4):810-5. doi: 10.1177/0363546510363664. Epub 2010 Mar 3.
High tibial osteotomy is technically demanding. Risks include injury to the popliteal neurovascular bundle. The present goal was to further define this risk.
The distance from the posterior tibia to the popliteal artery increases with increasing knee flexion. A saw angle perpendicular to the coronal plane can injure the popliteal artery.
Descriptive laboratory study.
Seven fresh-frozen cadaveric lower extremities were used. Lateral radiographs at knee flexion angles of 90 degrees , 60 degrees , 45 degrees , 30 degrees , and 0 degrees were taken to measure the distance from the anterior border of the popliteal artery to the posterior cortex of the tibia 5.0 mm and 2.0 cm below the joint line. After an opening wedge high tibial osteotomy was made, qualitative assessments were made of the depth of a saw blade inserted into the kerf and the relative encroachment of the saw blade on the popliteal artery. The interval through which the space anterior to the popliteus can be accessed was identified by gross dissection in all specimens.
The distance from the posterior tibia to the popliteal artery increased with knee flexion. At 5.0 mm and 2.0 cm below the joint line, the mean distance at 90 degrees was significantly greater than at all other angles. The popliteal artery could be injured by the oscillating saw at angles greater than 30 degrees to the coronal plane. A protective device inserted anterior to the popliteus protects the neurovascular structures.
The popliteal artery is farthest from the posterior tibia at 90 degrees of knee flexion. Saw angles greater than 30 degrees from the coronal plane put the popliteal neurovasculature at risk of injury.
To perform a safe osteotomy, the knee should be positioned in 90 degrees of flexion with the saw angled less than 30 degrees from the coronal plane. A protective device deep to the popliteus may protect against popliteal injury.
高位胫骨截骨术技术要求高。风险包括损伤腘血管神经束。目前的目标是进一步确定这种风险。
随着膝关节的弯曲，胫骨后缘到腘动脉的距离增加。与冠状面垂直的锯角可损伤腘动脉。
描述性实验室研究。
使用 7 个新鲜冷冻的下肢尸体标本。在膝关节屈曲角度为 90 度、60 度、45 度、30 度和 0 度时拍摄侧位 X 线片，测量关节线以下 5.0 毫米和 2.0 厘米处的腘动脉前缘到胫骨后皮质的距离。在进行开楔形高位胫骨截骨术后，对插入切口中的锯片深度和锯片对腘动脉的相对侵犯程度进行定性评估。在所有标本中，通过大体解剖确定了可以触及腘肌前方间隙的间隔。
随着膝关节的弯曲，胫骨后缘到腘动脉的距离增加。在关节线以下 5.0 毫米和 2.0 厘米处，90 度时的平均距离明显大于其他所有角度。当锯片与冠状面的夹角大于 30 度时，腘动脉可能会被摆动锯损伤。插入腘肌前方的保护装置可保护神经血管结构。
膝关节在 90 度屈曲时，腘动脉距离胫骨后缘最远。与冠状面成 30 度以上的锯角会使腘血管神经束有受伤的风险。
为了进行安全的截骨术，膝关节应在 90 度屈曲位置，锯片的角度应小于 30 度与冠状面成角。位于腘肌深面的保护装置可能会防止腘部损伤。
