Tonogai Ichiro, Hayashi Fumio, Tsuruo Yoshihiro, Sairyo Koichi
1 Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Kuramoto, Tokushima, Japan.
2 Department of Anatomy and Cell Biology, Institute of Biomedical Science, Tokushima University Graduate School, Kuramoto, Tokushima, Japan.
Foot Ankle Int. 2018 Jan;39(1):113-118. doi: 10.1177/1071100717732550. Epub 2017 Oct 27.
Anterior ankle arthroscopy is widely applied for various osteoarthropathies. However, distraction of the ankle may put the anterior tibial artery (ATA) at risk of injury during the procedure. The purpose of this study was to assess the difference in the distance between the anterior distal tibial edge and the ATA in distraction and nondistraction of the ankle with joint space expansion by saline injection into the joint.
Eight whole fresh-frozen cadaveric feet (mean age 78.9 years) were used. Barium sulfate suspension was injected into the popliteal artery of each specimen, and the distance from 3 aspects of the anterior distal tibial edge to the ATA was measured to evaluate the possibility of damage to the ATA based on computed tomography (CT) scans, in ankle distraction and nondistraction, using a traction device developed for reproducible ankle positioning inside the CT scanner.
The distance between the ATA and the most proximal, middle, and distal parts of the anterior distal tibial edge was 0.5 mm, 3.9 mm, and 7.4 mm, respectively, without saline injection, and 3.7 mm, 7.2 mm, and 11.6 mm, respectively, with saline injection, in nondistraction. The distance was 2.2 mm, 5.9 mm, and 9.8 mm, respectively, with 5-kg distraction, and 1.7 mm, 5.1 mm, and 8.8 mm, respectively, with 10-kg distraction, both with saline injection, respectively.
The distance between the anterior distal tibial edge and the ATA with joint space expansion by saline injection into the joint increased, and that distance in distraction of the ankle decreased during anterior arthroscopic surgery.
The anatomic relationship of the ATA to its surrounding structures may be at more risk without saline injection or with distraction during anterior ankle arthroscopy.
踝关节前路关节镜检查广泛应用于各种骨关节炎。然而，在手术过程中踝关节的牵引可能会使胫前动脉（ATA）面临损伤风险。本研究的目的是评估通过向关节内注射生理盐水使关节间隙扩大时，踝关节牵引和不牵引状态下胫前远端边缘与ATA之间距离的差异。
使用8只完整的新鲜冷冻尸体足（平均年龄78.9岁）。将硫酸钡悬浮液注入每个标本的腘动脉，并使用为在CT扫描仪内可重复定位踝关节而开发的牵引装置，根据CT扫描测量胫前远端边缘3个部位到ATA的距离，以评估在踝关节牵引和不牵引状态下ATA受损的可能性。
在不注射生理盐水的情况下，ATA与胫前远端边缘最近端、中间和远端部分之间的距离分别为\(0.5\)毫米、\(3.9\)毫米和\(7.4\)毫米；在注射生理盐水的情况下，不牵引时分别为\(3.7\)毫米、\(7.2\)毫米和\(11.6\)毫米。在注射生理盐水的情况下，\(5\)千克牵引时距离分别为\(2.2\)毫米、\(5.9\)毫米和\(9.8\)毫米，\(10\)千克牵引时分别为\(1.7\)毫米、\(5.1\)毫米和\(8.8\)毫米。
通过向关节内注射生理盐水使关节间隙扩大时，胫前远端边缘与ATA之间的距离增加，而在前路关节镜手术中踝关节牵引时该距离减小。
在前路踝关节镜检查中，不注射生理盐水或进行牵引时，ATA与其周围结构的解剖关系可能面临更高风险。
