Tonogai Ichiro, Fujimoto Eiki, Sairyo Koichi
Department of Orthopedics Surgery, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
Department of Cardiovascular Surgery, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
Case Rep Orthop. 2018 Nov 21;2018:9821738. doi: 10.1155/2018/9821738. eCollection 2018.
The use of standard anterolateral and anteromedial portals in ankle arthroscopy results in reduced risk of vascular complications. Anatomical variations of the arterial network of the foot and ankle might render the vessels more susceptible to injury during procedures involving the anterior ankle joint. The literature, to our knowledge, reports only one case of a pseudoaneurysm involving the peroneal artery after ankle arthroscopy. Here, we report the unusual case of a 48-year-old man in general good health with the absence of the anterior tibial artery and posterior tibial artery. The patient presented with a pseudoaneurysm of the perforating peroneal artery following ankle arthroscopy for traumatic osteoarthritis associated with nonunion of the medial malleolus. The perforating peroneal artery injury was repaired by performing end-to-end anastomosis. The perforating peroneal artery is at higher risk for iatrogenic injury during ankle arthroscopy in the presence of abnormal arterial variations of the foot and ankle, particularly the absence of the anterior tibial artery and posterior tibial artery. Before ankle arthroscopy, surgeons should therefore carefully observe the course of the perforating peroneal artery on enhanced 3-dimensional computed tomography, especially in patients with a history of trauma to the ankle joint.
在踝关节镜检查中使用标准的前外侧和前内侧入路可降低血管并发症的风险。足踝部动脉网络的解剖变异可能使血管在涉及踝关节前部的手术过程中更容易受到损伤。据我们所知，文献中仅报道了1例踝关节镜检查后腓动脉假性动脉瘤的病例。在此，我们报告1例48岁健康男性的罕见病例，该患者不存在胫前动脉和胫后动脉。该患者因创伤性骨关节炎伴内踝不愈合接受踝关节镜检查后出现腓穿支动脉假性动脉瘤。通过端端吻合修复腓穿支动脉损伤。在足踝部存在异常动脉变异，特别是不存在胫前动脉和胫后动脉的情况下，踝关节镜检查期间腓穿支动脉发生医源性损伤的风险更高。因此，在踝关节镜检查前，外科医生应在增强三维计算机断层扫描上仔细观察腓穿支动脉的走行，尤其是有踝关节创伤史的患者。
