Hernigou Jacques, Chahidi Esfandiar, Kashi Mahine, Moest Eric, Dakhil Bassel, Hayek Georges, Callewier Antoine, Schuind Frederic, Bath Olivier
Department of Orthopaedic and Traumatology Surgery, Centre Hospitalier EpiCURA/Université Libre de Bruxelles, Rue Louis Caty 136, 7331, Baudour, Belgium.
Department of Orthopaedic and Traumatology Surgery, Erasme Hospital/Université Libre de Bruxelles, Route de Lennik 808, 1070, Bruxelles, Belgium.
Int Orthop. 2018 May;42(5):1165-1174. doi: 10.1007/s00264-017-3554-7. Epub 2017 Jul 9.
During tibial tubercle transfer, popliteal vessels are at risk from drills and screws. The risk is around 0.11%, as described in the literature. We reviewed knee injected CT scan for analysis of the location of arteries, identified landmarks allowing minimizing risks, and defined a safe zone.
Distances between the posterior cortex and arteries were measured on CT scans from 30 adults (60 knees) at three levels (proximal part of the tibial tuberosity, 20 mm and 40 mm distally). Data were used to create a "risk map" with different angular sectors where the frequency of the presence of arteries was analyzed in each area. We also analyzed the position of 68 screws of 47 patients who underwent a medial tibial tuberosity transfer.
The nearest distance between artery and the posterior tibial cortex was found at the level corresponding to the top of the tuberosity with less than 1 mm, while the largest distance was found at the distal level. We were able to define a safe zone for drilling through the posterior tibial cortex which allows a safe fixation for the screws. This zone corresponds to the medial third of the posterior cortex. When the safe zone is not respected, screws that overtake the posterior cortex may be close to arteries as observed for 37 of the 68 screws analyzed.
We described new landmarks and recommendations to avoid this complication during tibial tuberosity transfer.
在胫骨结节转移过程中，腘血管有被钻头和螺钉损伤的风险。如文献所述，该风险约为0.11%。我们回顾了膝关节注射CT扫描图像，以分析动脉位置，确定可将风险降至最低的标志点，并定义一个安全区域。
在30名成年人（60个膝关节）的CT扫描图像上，测量胫骨后皮质与动脉在三个水平（胫骨结节近端、远端20毫米和40毫米处）之间的距离。数据用于创建一个“风险地图”，该地图具有不同的角扇形区域，分析每个区域动脉存在的频率。我们还分析了47例行胫骨结节内侧转移患者的68枚螺钉的位置。
在对应于结节顶部的水平处，发现动脉与胫骨后皮质之间的最短距离小于1毫米，而在远端水平处发现最大距离。我们能够确定一个通过胫骨后皮质钻孔的安全区域，该区域允许对螺钉进行安全固定。该区域对应于后皮质的内侧三分之一。当不遵循安全区域时，如在分析的68枚螺钉中的37枚中观察到的那样，穿过胫骨后皮质的螺钉可能靠近动脉。
我们描述了新的标志点和建议，以避免在胫骨结节转移过程中出现这种并发症。
