Hospital for Special Surgery, New York, NY, USA.
Foot Ankle Int. 2010 Nov;31(11):987-93. doi: 10.3113/FAI.2010.0987.
Avascular necrosis following a fracture of the talar neck may be secondary to the injury itself, or may result from the surgical approach and exposure during treatment. We sought to define the arterial anatomy of the talus using gadolinium-enhanced magnetic resonance imaging (MRI) and through gross dissection following latex injection of cadaver limbs. The use of gadolinium-enhanced MRI for the evaluation of the arterial supply of the talus has not been previously reported.
We utilized 12 fresh frozen cadaver limbs to study the arterial anatomy of the talus. The anterior tibial, posterior tibial, and peroneal arteries were isolated and cannulated with polyethylene catheters. Gadolinium was injected into the cannulas, and conventional MRI sequences including suppressed and unsuppressed 3D gradient echo sequences obtained. Following MRI, latex was injected into the cannulas and gross dissection performed. In addition, the vascular constraints to anteromedial and anterolateral approaches to the talus were defined.
MRI proved useful in the present study to confirm the presence of specific arterial branches in situ, as well as to demonstrate the rich anastomotic network in and around the talus. A branch to the medial talar neck that has not been previously identified is described which was found in nine of the specimens. This newly described branch to the medial talar neck was consistently noted to be lacerated following a standard anteromedial approach to the talus.
The use of gadolinium-enhanced MRI provided very detailed images demonstrating a rich and complex anastomotic arterial network that surrounds and perforates the talus.
A thorough understanding of the anatomy and meticulous dissection are essential to prevent unnecessary further injury to the vasculature when treating fractures of the talus.
距骨颈骨折后发生的缺血性坏死可能是由损伤本身引起的，也可能是由于治疗过程中的手术入路和暴露引起的。我们试图使用钆增强磁共振成像（MRI）并通过乳胶注射后的大体解剖来定义距骨的动脉解剖结构。尚未有报道使用钆增强 MRI 评估距骨的血供。
我们使用 12 个新鲜冷冻的尸体肢体来研究距骨的动脉解剖结构。分离并通过聚乙烯导管对胫前动脉、胫后动脉和腓动脉进行插管。将钆注入导管中，并获得包括抑制和未抑制的 3D 梯度回波序列在内的常规 MRI 序列。MRI 后，向导管中注入乳胶并进行大体解剖。此外，还定义了距骨前内侧和前外侧入路的血管限制。
MRI 在本研究中被证明是有用的，可以确认特定动脉分支的存在，并显示距骨内和周围丰富的吻合网络。描述了一种以前未识别的距骨颈内侧分支，在九个标本中均发现了该分支。在后入路治疗距骨时，始终注意到这条新描述的距骨颈内侧分支被撕裂。
使用钆增强 MRI 提供了非常详细的图像，显示了丰富而复杂的吻合动脉网络，环绕并穿透距骨。
全面了解解剖结构并进行精细解剖对于治疗距骨骨折时防止对血管的不必要进一步损伤至关重要。
