[胫骨截骨延长术的血管解剖学研究]

[VASCULAR ANATOMICAL STUDY ON TIBIAL OSTEOTOMY LENGTHENING].

作者信息

Wang Bin, Wang Pengfei, Wang Yupeng, Jia Song, Yang Huanyou, Yin Jiali, Jiang Wenping, Zhao Gang

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Jul;29(7):835-9.

PMID:26540976

Abstract

OBJECTIVE

To provide the anatomical basis for the selection of osteotomy site in leg lengthening or tibial slip.

METHODS

Between August 2010 and July 2014, 10 adult fresh amputated leg specimens were collected. The pressure perfusion of red latex was performed by the popliteal artery. The anterior tibial artery and its main branches were separated and exposed, and the periosteal branch of anterior tibial artery was adequately exposed; the posterior tibial artery and its main branches were exposed; the peroneal artery was separated and exposed. The tibial and peroneal artery and its branches were observed and measured. When measuring the proximal end, the medial tibial plateau bone margin, the most prominent part of the tibial tuberosity, and the fibular head edge were used as a reference; when measuring the distal end, distal medial condyle of tibia malleolus tip, tibial lateral malleolus lateral tip, and distal tibial articular surface were used as a reference; the vertical distance between tibia proximal and distal main arteries and bone end reference was measured to determine the optimal osteotomy position of upper and lower tibia. The osteotomy index was calculated which was used to represent the relative position of osteotomy site in the whole tibia.

RESULTS

The proximal tibial osteotomy site located at (78.2 ± 19.5) mm from medial tibial plateau margin, (41.8 ± 16.0) mm from the tibial tuberosity pole, and (66.7 ± 16.4) mm from the fibular head edge. The distal tibial osteotomy site located at (70.8 ± 12.1) mm above the inferior margin of tibial medial malleolus, (83.3 ± 13.0) mm above the inferior margin of lateral malleolus tip, and (59.1 ± 11.7) mm from distal tibial articular surface. The proximal tibial osteotomy index was 18.45-23.35 (mean, 20.46); the distal tibial osteotomy index was 14.36-23.05 (mean, 18.81).

CONCLUSION

The metaphyseal-diaphyseal connection shold be selected in the proximal and distal tibia osteotomy, the lower one third of the tibia is not suitable for ostetomy.

摘要

目的

为腿部延长或胫骨滑移截骨部位的选择提供解剖学依据。

方法

2010年8月至2014年7月，收集10例成人新鲜截肢小腿标本。经腘动脉进行红色乳胶压力灌注。分离并暴露胫前动脉及其主要分支，充分暴露胫前动脉的骨膜支；暴露胫后动脉及其主要分支；分离并暴露腓动脉。观察并测量胫腓动脉及其分支。测量近端时，以胫骨内侧平台骨缘、胫骨结节最突出部位及腓骨头边缘为参照；测量远端时，以胫骨内踝尖远端、胫骨外踝外侧尖及胫骨远端关节面为参照；测量胫骨近端和远端主要动脉与骨端参照之间的垂直距离，以确定胫骨上下端的最佳截骨位置。计算截骨指数，用于表示截骨部位在整个胫骨中的相对位置。

结果

胫骨近端截骨部位位于距胫骨内侧平台边缘（78.2±19.5）mm、距胫骨结节极点（41.8±16.0）mm、距腓骨头边缘（66.7±16.4）mm处。胫骨远端截骨部位位于胫骨内踝下缘上方（70.8±12.1）mm、外踝尖下缘上方（83.3±13.0）mm、距胫骨远端关节面（59.1±11.7）mm处。胫骨近端截骨指数为18.45 - 23.35（平均20.46）；胫骨远端截骨指数为14.36 - 23.05（平均18.81）。