应用外周静脉照明装置减少关节镜下踝关节融合术中螺钉置入引起的隐静脉结构损伤。

Application of a peripheral vein illumination device to reduce saphenous structure injury caused by screw insertion during arthroscopic ankle arthrodesis.

作者信息

Nakasa Tomoyuki, Ikuta Yasunari, Tsuyuguchi Yusuke, Ota Yuki, Kanemitsu Munekazu, Adachi Nobuo

机构信息

Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minamiku, Hiroshima city, 734-8551, Japan.

出版信息

J Orthop Sci. 2019 Jul;24(4):697-701. doi: 10.1016/j.jos.2018.12.007. Epub 2019 Jan 7.

DOI:10.1016/j.jos.2018.12.007

PMID:30630767

Abstract

BACKGROUND

Arthroscopic ankle arthrodesis (AAA) is minimally invasive surgery, whereby percutaneous screw fixation is used through the medial aspect of the distal tibia to fusion the ankle, but it carries the risk of the saphenous vein and nerve injuries. The near-infrared (NIR) vascular imaging system, the VeinViewer Flex, projects an image of the vein onto the skin, and the visualization of the vein may reduce the vein and nerve injuries. The purpose of this study is to investigate the risk of the saphenous vein injury by the percutaneous screw insertion during AAA, and to evaluate the effectiveness of the NIR vascular imaging system in the reduction of the saphenous vein injury.

METHODS

Ten patients with the ankle osteoarthritis underwent AAA. Three screw insertion sites (proximal as number 1, anterior distal as number 2, and posterior distal as number 3) were marked and then the vein was depicted on the medial malleolus using the VeinViewer Flex. The distance between the screw insertion sites and the closest vein was measured. Additionally, the pattern of the vein course on the medial aspect of the distal tibia was investigated in 32 ankles using the VeinViewer Flex.

RESULTS

The distance of number 1, 2, and 3 from the vein was 2.4 ± 1.4 mm (range from 0 to 5 mm), 6.3 ± 6.6 mm (range from 0 to 20 mm) and 3.5 ± 3.1 mm (range from 0 to 11 mm) respectively. In anterior screw insertion site, 3 of 10 cases showed just on the vein. The veins were observed at the anterior region from the center axis of the tibia more than 75% of ankles which was suspected as the greater saphenous vein with closely running of the saphenous nerve, but also other regions had the crossing vein.

CONCLUSIONS

Percutaneous screw fixation during AAA runs the risk of causing the saphenous structure injury. The NIR light imaging system is beneficial in reducing the complications of saphenous structure damage in AAA.

摘要

背景

关节镜下踝关节融合术（AAA）是一种微创手术，通过胫骨远端内侧经皮螺钉固定来实现踝关节融合，但存在大隐静脉和神经损伤的风险。近红外（NIR）血管成像系统VeinViewer Flex可将静脉图像投射到皮肤上，静脉可视化可能会减少静脉和神经损伤。本研究的目的是调查AAA手术中经皮螺钉插入导致大隐静脉损伤的风险，并评估NIR血管成像系统在减少大隐静脉损伤方面的有效性。

方法

10例踝关节骨关节炎患者接受了AAA手术。标记三个螺钉插入部位（近端为1号，前远端为2号，后远端为3号），然后使用VeinViewer Flex在内踝描绘静脉。测量螺钉插入部位与最近静脉之间的距离。此外，使用VeinViewer Flex对32个踝关节胫骨远端内侧的静脉走行模式进行了研究。

结果

1号、2号和3号部位与静脉的距离分别为2.4±1.4毫米（范围为0至5毫米）、6.3±6.6毫米（范围为0至20毫米）和3.5±3.1毫米（范围为0至11毫米）。在前侧螺钉插入部位，10例中有3例刚好位于静脉上。超过75%的踝关节在胫骨中轴线前方区域观察到静脉，怀疑为大隐静脉，且大隐神经与之紧密伴行，但其他区域也有交叉静脉。