Gerich T, Lens V, Seil R, Pape D
Traumatologie des Centre Hospitalier de Luxembourg, 4, rue Barblé, 1410, Luxembourg, Luxembourg,
Orthopade. 2014 Nov;43(11):1008-15. doi: 10.1007/s00132-014-3028-1.
Lesions of the popliteal artery during high tibial osteotomy are rare complications, consequently the majority of publications are case related. The interval between surgery and diagnosis is reported to be as long 3 years; therefore, the current literature probably does not reflect the true incidence of vascular injuries.
The case reports published in the literature were further evaluated. The focus was on the normal vascular anatomy of the popliteal region and anatomical deviations that predispose to vascular injury. As the flexion angle of the knee joint is considered to be decisive for vascular injury, this aspect was also an additional focus. For the unlikely event of a vascular injury, recommendations are presented which indicate diagnostic and therapeutic decisions.
We analyzed the available literature and present own magnetic resonance imaging (MRI) investigations of the popliteal artery with different angles of flexion in six healthy volunteers.
A variation of the origin of the anterior tibial artery with a course between the posterior tibial cortex and the popliteal muscle was found in 6% of all patients and predisposes to an accidental injury during osteotomy. The results in the literature and our own MRI findings suggest that a flexion angle of 90° facilitates anatomical dissection and osteotomy but cannot be regarded as a reliable protection against vascular injury.
胫骨高位截骨术中腘动脉损伤是罕见的并发症，因此大多数文献报道均为病例相关。据报道，手术与诊断之间的间隔长达3年；因此，当前文献可能并未反映血管损伤的真实发生率。
对文献中发表的病例报告进行进一步评估。重点关注腘窝区域的正常血管解剖结构以及易导致血管损伤的解剖变异。由于膝关节的屈曲角度被认为是血管损伤的决定性因素，这方面也是一个额外的重点。针对不太可能发生的血管损伤情况，提出了表明诊断和治疗决策的建议。
我们分析了现有文献，并展示了对6名健康志愿者在不同屈曲角度下腘动脉的磁共振成像（MRI）研究。
在所有患者中，6%发现胫前动脉起源变异，走行于胫骨后皮质与腘肌之间，这易导致截骨术中意外损伤。文献结果和我们自己的MRI研究结果表明，90°的屈曲角度便于解剖分离和截骨，但不能被视为防止血管损伤的可靠保护措施。
