Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
Foot Ankle Int. 2013 Apr;34(4):568-74. doi: 10.1177/1071100713479318. Epub 2013 Feb 13.
For triple arthrodesis, a single medial incision has been proposed to avoid lateral wound complications and has demonstrated satisfactory fusion rates. This study aimed to compare the disruption to the arterial supply of the talus between the single-medial-incision approach and the 2-incision approach.
The 2 approaches for triple arthrodesis were compared by analyzing the disruption of arterial vasculature in 14 cadaveric specimens in randomized fashion. The arterial disruption was determined using CT angiography before and after surgery combined with analysis from dissection. The area of joint preparation from each technique was also analyzed and compared.
The single-medial-incision approach caused a high incidence of damage to the deltoid artery (6 of 7 specimens, 86%) and the artery of the tarsal canal (7 of 7 specimens, 100%). The 2-incision approach resulted in damage to the artery of the tarsal sinus in all specimens (7 of 7 specimens, 100%), but the medial vasculature was spared given the limited dissection required to access the talonavicular joint. Through the single-medial-incision approach the percentage of debridement of the calcaneocuboid joint (36%) was significantly lower than the debridement using the 2-incision approach (85%, P < .01). There was no significant difference in joint preparation of the talonavicular and subtalar joints between the 2 approaches with the number of specimens available.
From this cadaveric study, we found that both approaches could result in substantial disruption of the main blood supply to the talus. The single-medial-incision approach consistently disrupted the majority of blood supply to the talar body, while the 2-incision approach caused various degrees of vascular disruption to the talar head and neck. Using the single-medial-incision approach, the calcaneocuboid joint did not show adequate removal of articular cartilage due to difficulty accessing the joint surfaces.
Vascular sparing to the talus should be considered when selecting an appropriate operative approach for triple arthrodesis. Although the clinical significance of this cadaveric study is limited, the 2-incision approach appeared to cause less vascular disruption to the talar body while allowing more complete joint preparation.
对于三关节融合术，单一内侧入路已被提出以避免外侧伤口并发症，并已证明融合率令人满意。本研究旨在比较单一切口入路与双切口入路对距骨动脉供应的破坏。
通过随机比较 14 个尸体标本的两种三关节融合术入路，分析动脉血管的破坏。在手术前后，采用 CT 血管造影术结合解剖分析来确定动脉的破坏情况。还分析并比较了每种技术的关节准备面积。
单一切口入路导致三角动脉（7 个标本中的 6 个，86%）和跗管动脉（7 个标本中的 7 个，100%）高发生率损伤。双切口入路导致所有标本（7 个标本中的 7 个，100%）的跗骨窦动脉损伤，但由于进入跟舟关节所需的有限解剖，内侧血管得以保留。通过单一切口入路，跟骰关节的清创百分比（36%）明显低于双切口入路（85%，P<.01）。两种入路对距跟和距下关节的关节准备无显著差异，因为可用的标本数量有限。
从这项尸体研究中，我们发现两种入路都可能导致距骨主要血供的实质性破坏。单一切口入路始终破坏距骨体的大部分血供，而双切口入路导致距骨头颈部的不同程度的血管破坏。使用单一切口入路，由于难以接近关节表面，跟骰关节未显示出足够的关节软骨清除。
在选择适当的三关节融合术手术入路时，应考虑距骨的血管保留。虽然这项尸体研究的临床意义有限，但双切口入路似乎对距骨体的血管破坏较小，同时允许更完全的关节准备。
