Jiamton C, Apivatthakakul T
Institute of Orthopaedics, Lerdsin General Hospital, Bangkok, Thailand.
Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Excellence Center in Osteology Research and Training Center (ORTC), Chiang Mai University, Thailand.
Injury. 2015 Nov;46(11):2170-6. doi: 10.1016/j.injury.2015.08.032. Epub 2015 Aug 31.
Minimally invasive plate osteosynthesis (MIPO) on the medial side of the femur appears to be a dangerous procedure due to possible femoral artery injury.
This study aims to determine the feasibility of applying MIPO of the femur via the medial approach, and to determine the anatomical relationship and structures at risk between the artery and the implant using computed tomography angiography.
A descriptive study of ten fresh cadavers was done. Two separate incisions were made, creating a submuscular tunnel close to the medial side of the femur. An 11- or 13-hole LCP lateral proximal tibial plate (5.0mm) was inserted through the distal incision into the submuscular tunnel and fixed. A CT angiogram with 3D reconstruction was made to determine the distance from and location of the plate relative to the femoral artery and surgical dissection was done to identify the structures at risk.
No disruptions of superficial or deep femoral arteries were found. The closest distances from the superficial femoral artery and deep femoral artery to the plate were 8.3-27.2mm (average 16.3mm) (99% CI: 12.7-19.9) at the level 3 and 4.5-20.0mm (average 8.6mm) (99% CI: 6.4-10.9) at the level 2 in the proximal part of femur, respectively. The location where the SFA crossed the anterior cortex of the femur in the sagittal plane was 9.7-36.0% of the femoral length (average 20.1%) (99% CI: 15.0-25.3%) and the posterior cortex of the femur was 24.7-55.3% of the femoral length (average 40.8%) (99% CI: 35.0-46.7%). The location where the DFA crossed the anterior cortex of the femur in the sagittal plane was 7.9-25.3% of the femoral length (average 13.4%) (99% CI: 10.6-16.3%) and where it crossed the posterior cortex of the femur was 21.7-39.4% of the femoral length (average 31.2%) (99% CI: 27.1-33.3%).
MIPO of the femur via medial approach is a feasible option for treatment of femoral fractures when the lateral approach is contraindicated. The distal 60% of the femoral length is safe for this approach.
由于可能损伤股动脉，股骨内侧微创钢板接骨术（MIPO）似乎是一种危险的手术。
本研究旨在确定经内侧入路应用股骨MIPO的可行性，并使用计算机断层血管造影确定动脉与植入物之间的解剖关系和有风险的结构。
对10具新鲜尸体进行描述性研究。做两个单独的切口，在靠近股骨内侧创建一个肌下隧道。将一块11孔或13孔的5.0mm外侧胫骨近端锁定加压钢板（LCP）通过远端切口插入肌下隧道并固定。进行三维重建的CT血管造影，以确定钢板相对于股动脉的距离和位置，并进行手术解剖以识别有风险的结构。
未发现股浅动脉或股深动脉中断。在股骨近端，股浅动脉和股深动脉到钢板的最近距离在3级分别为8.3 - 27.2mm（平均16.3mm）（99%可信区间：12.7 - 19.9），在2级分别为4.5 - 20.0mm（平均8.6mm）（99%可信区间：6.4 - 10.9）。在矢状面，股浅动脉穿过股骨前皮质的位置为股骨长度的9.7 - 36.0%（平均20.1%）（99%可信区间：15.0 - 25.3%），穿过股骨后皮质的位置为股骨长度的24.7 - 55.3%（平均40.8%）（99%可信区间：35.0 - 46.7%）。股深动脉在矢状面穿过股骨前皮质的位置为股骨长度的7.9 - 25.3%（平均13.4%）（99%可信区间：10.6 - 16.3%），穿过股骨后皮质的位置为股骨长度的21.7 - 39.4%（平均31.2%）（99%可信区间：27.1 - 33.3%）。
当外侧入路禁忌时，经内侧入路的股骨MIPO是治疗股骨骨折的一种可行选择。股骨长度的远端60%对该入路是安全的。
