Lidder S, Masterson S, Grechenig C, Clement H, Gänsslen A, Grechenig S
Guy's and St Thomas' nHS Foundation Trust, Department of Trauma and Orthopaedics, London, UK.
Acta Chir Orthop Traumatol Cech. 2014;81(5):313-6.
Percutaneous plating of the distal tibia via a limited incision is an accepted technique of osteosynthesis for extra-articular and simple intra-articular distal tibia fractures. The aim of this study was to analyze structures that are at risk during this approach.
Thirteen unpaired adult lower limbs were used for this study. Thirteen, 15-hole LCP anterolateral distal tibial plates were percutaneously inserted according to the recommended technique. Dissection was performed to examine the relation of the superficial and deep peroneal nerves and anterior tibial artery relative to the plate.
The superficial peroneal nerve was found to cross the vertical limb of the LCP plate at a mean distance of 63 mm (screw hole five) but with a wide range of 21 to 105 mm. The neurovascular bundle (deep peroneal nerve and anterior tibial artery) crossed the plate at a mean of 76 mm (screw hole six) but also with a wide range of 38 to 138 mm. The zone of danger of the neurovascular structures ranges from 21 to 138 mm from the tibial plafond. In one specimen, a significant branch of the deep peroneal nerve was found to be entrapped under the plate.
Caution is advised when using anterolateral minimally invasive technique for plate insertion and screw placement in the distal tibia due to great variability in the neurovascular structures that course distally in the lower leg and cross the ankle.
经有限切口对胫骨远端进行经皮钢板固定是治疗胫骨远端关节外及单纯关节内骨折的一种公认的骨内固定技术。本研究旨在分析该手术入路过程中存在风险的结构。
本研究使用了13例未配对的成人下肢。按照推荐技术经皮插入13块15孔的胫骨远端外侧锁定加压钢板（LCP）。进行解剖以检查腓浅神经和腓深神经以及胫前动脉与钢板的关系。
发现腓浅神经在距LCP钢板垂直臂平均63 mm（螺孔5）处穿过，但范围较宽，为21至105 mm。神经血管束（腓深神经和胫前动脉）在平均76 mm（螺孔6）处穿过钢板，但范围也较宽，为38至138 mm。神经血管结构的危险区域距胫骨平台21至138 mm。在1个标本中，发现腓深神经的一个重要分支被钢板卡压。
由于小腿远端走行并穿过踝关节的神经血管结构变异很大，因此在使用胫骨远端前外侧微创技术插入钢板和拧入螺钉时建议谨慎操作。
