Nebraska Medical Center, Omaha, NE 68198-2258, USA.
J Orthop Trauma. 2011 Oct;25(10):603-7. doi: 10.1097/BOT.0b013e318206fa99.
This study was undertaken to determine if there is increased likelihood of popliteal artery injury as one places a fixed-angle lateral proximal tibia locking plate with posterior plate lift off and or anterior plate translation from the ideal position.
A Synthes (Synthes USA, West Chester, PA) 3.5-mm and 4.5-mm lateral proximal tibia locking plate was placed consecutively on each of six specimens in the straight lateral (SL) position. Screw position with respect to the medial cortex was recorded as well as the distance of the posterior most screw tip to the popliteal artery. Next a 3-mm shim was placed under the posterior edge of the same plate to mimic posterior plate lift off (LO) followed by placement of a 6-mm shim. The same experiment was repeated with the plate translated 5 mm anteriorly (AT).
The popliteal artery was injured in zero of six specimens using the 3.5-mm plate. The popliteal artery was injured in six of six specimens using the 4.5-mm plate in the 5-mm AT 6-mm LO position, five of six with 5-mm AT and 3-mm LO, two of six with only 5-mm AT, four of six with SL and 6-mm LO, two of six with SL and 3-mm LO, and zero of six with SL.
The Synthes 4.5-mm plate can put the popliteal artery at risk with as little as 3-mm posterior liftoff in the intended straight lateral position or with 5-mm anterior plate translation with no posterior liftoff. Therefore, placement of the 4.5-mm plate in the proper position and confirmation of its position with a true lateral radiograph is paramount to avoid injury to the popliteal artery.
本研究旨在确定在将固定角度的外侧胫骨近端锁定板从理想位置向后抬起（后板抬起）和/或向前平移（前板平移）时，是否更有可能损伤腘动脉。
连续将 6 个标本中的每个标本置于标准外侧（SL）位置的 Synthes（Synthes USA，West Chester，PA）3.5mm 和 4.5mm 外侧胫骨近端锁定板。记录螺钉相对于内侧皮质的位置以及最靠近后缘的螺钉尖端到腘动脉的距离。然后在后缘下方放置 3mm 垫片以模拟后板抬起（LO），然后再放置 6mm 垫片。用同样的实验重复板向前平移 5mm（AT）的情况。
使用 3.5mm 板时，6 个标本中有 0 个损伤腘动脉。使用 4.5mm 板时，在 5mm AT 6mm LO 位置，6 个标本中有 6 个损伤腘动脉，5 个标本中有 5mm AT 和 3mm LO，2 个标本中有 5mm AT，6 个标本中有 4 个 SL 和 6mm LO，6 个标本中有 2 个 SL 和 3mm LO，6 个标本中有 0 个 SL。
Synthes 4.5mm 板即使在后板抬起 3mm 或前板平移 5mm 且无后板抬起的情况下，也会使腘动脉处于危险之中。因此，正确放置 4.5mm 板并通过真正的侧位 X 线片确认其位置对于避免损伤腘动脉至关重要。
