Kim Jung Jae, Oh Hyoung Keun, Bae Joo-Yul, Kim Ji Wan
Injury. 2014 Dec;45(12):1964-9. doi: 10.1016/j.injury.2014.09.023.
Surgical treatment options for distal femur fractures include intramedullary nailing or plating using a lateral or lateral parapatellar approach. However, medial plating is required for additional stability in some fractures such as severely comminuted fractures and periprosthetic fractures, and in those for which use of a lateral plate or nail is not appropriate. This study aimed to explore the safe zone for medial minimally invasive plate osteosynthesis of the distal femur with computed tomography angiography.
In a series of 30 patients, the region of interest between the lesser trochanter (LT) to the adductor tubercle (AT) was divided into six levels (I to VI), and the distance from the femur to the femoral artery (FA) was measured. At each level, the medial half of the femur was divided into eight sections that were assigned ‘A to H’ from anteromedial to posteromedial, and the position of the FA and the deep femoral artery (DFA) was recorded.
The average length from the LT to AT was 295.0 mm. The average distance to FA was 38.0 mm, 29.9 mm, 26.9 mm, 27.0 mm, 21.8 mm, and 12.2 mm from level I to VI, respectively. The FA was positioned posteromedially below level IV and positioned at C–H below level II, which was out of the anterior aspect of the femur. The DFA was in the same location as the FA between levels II and III.
The anteromedial aspect of the distal half of the femur is the safe zone, and a long plate can be positioned safely in this zone at the anterior aspect up to the level of 8 cm below the LT.
股骨远端骨折的手术治疗选择包括髓内钉固定或采用外侧或外侧髌旁入路进行钢板固定。然而，对于一些骨折，如严重粉碎性骨折和假体周围骨折，以及不适合使用外侧钢板或髓内钉的情况，需要内侧钢板固定以提供额外的稳定性。本研究旨在通过计算机断层血管造影探索股骨远端内侧微创钢板接骨术的安全区域。
在30例患者中，将小转子（LT）至内收肌结节（AT）之间的感兴趣区域分为六个层面（I至VI），测量股骨与股动脉（FA）之间的距离。在每个层面，将股骨内侧半部分为八个节段，从股骨内侧前方向后内侧依次标记为“A至H”，记录FA和股深动脉（DFA）的位置。
LT至AT的平均长度为295.0mm。从I至VI层面，到FA的平均距离分别为38.0mm、29.9mm、26.9mm、27.0mm、21.8mm和12.2mm。FA在IV层面以下位于后内侧，在II层面以下位于C至H节段，位于股骨前方之外。DFA在II和III层面之间与FA位于同一位置。
股骨远端下半部分的前内侧是安全区域，在此区域内，长钢板可安全地置于LT下方8cm水平的前方。
