Department of Trauma and Orthopaedics, University Hospitals, Coventry and Warwickshire, Coventry, UK.
Foot Ankle Int. 2012 Dec;33(12):1139-44. doi: 10.3113/FAI.2012.1139.
Minimally invasive surgery (MIS) aims to improve cosmesis and minimize soft tissue disruption by using small skin incisions. When using MIS in the forefoot, there is concern about iatrogenic neurovascular and tendon damage. The aim of this anatomical study was to assess the risk of iatrogenic injury while performing MIS techniques.
Ten normal cadaveric feet were used. All of the procedures were performed in a cadaveric lab using a mini-C-arm by two surgeons: a consultant who has attended a cadaveric MIS training course but does not perform MIS in his regular practice (eight feet) and a registrar (resident) who was supervised by the same consultant (two feet). In each foot, the surgeon performed a lateral release, a minimally invasive chevron and Akin (MICA) procedure for the correction of hallux valgus, and a minimally invasive distal metatarsal extra-articular osteotomy (DMO). Each foot was then dissected to identify any neurovascular or tendon injury and photographed.
The dorsal medial cutaneous and the plantar interdigital nerves were intact in all specimens. There was no apparent damage to the arterial plexus supplying the first metatarsal head. No flexor or extensor tendon injuries were identified. On examination of the osteotomies, the cuts were found not to be in the desired plane. In both MICA and DMO, the dissection also revealed some intact soft tissue at the osteotomy site, which may preserve vascularity and add stability to the osteotomy.
Although there has been concern regarding neurovascular and tendon injury, the findings were consistent with minimal risk, which is consistent with reports in the literature. This study also reflects the challenges associated with performing the osteotomy in the desired plane, which may be related to the learning curve.
This cadaveric study has demonstrated a minimal risk of neurovascular and tendon injury associated with minimally invasive techniques in the forefoot. However, the study emphasizes the need for excellent three-dimensional anatomy and suggests additional cadaveric training prior to attempting these techniques in clinical practice.
微创外科 (MIS) 通过使用小切口来改善美容效果并尽量减少软组织损伤。在足前部使用 MIS 时，人们担心会造成医源性的神经血管和肌腱损伤。本解剖学研究的目的是评估在进行 MIS 技术时发生医源性损伤的风险。
使用两位外科医生对 10 具正常尸体足进行了研究。所有手术均在尸体实验室中使用 mini-C 臂由两位外科医生进行：一位顾问参加了尸体 MIS 培训课程但不在其常规实践中进行 MIS（8 只脚），另一位注册医师（住院医师）由同一位顾问监督（2 只脚）。在每只脚上，外科医生进行了外侧松解术、微创 Chevron 和 Akin（MICA）手术矫正拇外翻以及微创远节跖骨关节外截骨术（DMO）。然后，对每只脚进行解剖以确定是否存在神经血管或肌腱损伤并拍照。
所有标本的背侧内侧皮神经和足底趾间神经均完整。第一跖骨头的动脉丛没有明显损伤。没有发现屈肌或伸肌肌腱损伤。在检查截骨术时，发现切口不在所需的平面上。在 MICA 和 DMO 中，解剖还发现截骨部位有一些完整的软组织，这可能有助于保持血供并增加截骨的稳定性。
尽管存在有关神经血管和肌腱损伤的担忧，但研究结果表明风险极小，这与文献报道一致。本研究还反映了在所需平面上进行截骨的相关挑战，这可能与学习曲线有关。
这项尸体研究表明，在前足进行微创技术时，神经血管和肌腱损伤的风险很小。但是，该研究强调了需要出色的三维解剖知识，并建议在尝试将这些技术应用于临床实践之前进行额外的尸体培训。
