Sirisreetreerux Norachart, Shafiq Babar, Osgood Greg M, Hasenboehler Erik A
*Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD; and †Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Orthop Trauma. 2016 Nov;30(11):e357-e361. doi: 10.1097/BOT.0000000000000659.
To determine the location of distal medial neurovascular structures, identifying a medial "safe zone" for minimally invasive plate osteosynthesis to treat displaced femoral condylar fractures.
Eleven uninjured lower-half torsos were dissected on the bilateral medial lower thigh. A longitudinal incision was made at the midsagittal plane of the medial thigh starting 1 cm proximal to the knee joint and extending to the proximal one-third of the femur. Superficial and deep neurovascular structures were dissected. Distances to the medial vastus and adductor compartment were measured.
Mean distances were 160 ± 31.4 mm from the adductor tubercle to Hunter canal; 94 ± 18.3 mm from adductor tubercle to adductor hiatus; 31.8 ± 9.21 mm from Hunter canal to the femoral shaft; and 31.7 ± 7.78 mm from adductor hiatus to femoral shaft. All specimens had a descending genicular artery (DGA) with a mean distance to the adductor tubercle of 98.4 ± 16.0 mm. The muscular branch of the DGA crossed the femoral shaft at approximately 50 mm from the adductor tubercle; the osteoarticular branch ran along the adductor magnus tendon. The nerve to the vastus medialis was at the posterior border of the vastus medialis, entering at a mean 143 ± 63.0 mm from the adductor tubercle.
Minor neurovascular branches of the DGA may be vulnerable during medial femoral condyle plating. Careful blunt dissection, proper instrumentation, and plate length within 160 mm allow distal medial femur fixation without additional proximal dissection.
确定远端内侧神经血管结构的位置，确定用于微创钢板接骨术治疗移位型股骨髁骨折的内侧“安全区”。
对11具未受伤的下半身躯干进行双侧大腿内侧解剖。在大腿内侧矢状面作一纵向切口，起自膝关节近端1 cm处，延伸至股骨近端三分之一处。解剖浅、深神经血管结构。测量到股内侧肌和内收肌间隙的距离。
从内收肌结节到亨特管的平均距离为160±31.4 mm；从内收肌结节到内收肌裂孔的平均距离为94±18.3 mm；从亨特管到股骨干的平均距离为31.8±9.21 mm；从内收肌裂孔到股骨干的平均距离为31.7±7.78 mm。所有标本均有膝降动脉（DGA），其到内收肌结节的平均距离为98.4±16.0 mm。DGA的肌支在距内收肌结节约50 mm处穿过股骨干；骨关节支沿内收大肌腱走行。股内侧肌神经位于股内侧肌的后缘，从内收肌结节进入的平均距离为143±63.0 mm。
在股骨内侧髁钢板固定时，DGA的微小神经血管分支可能易受损。仔细钝性分离、正确使用器械以及钢板长度在160 mm以内，可在不进行额外近端分离的情况下进行股骨远端内侧固定。
