Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria.
AUVA Trauma Hospital Styria, Göstinger Straße 24, 8020 Graz, Austria.
Injury. 2021 Sep;52 Suppl 5:S11-S16. doi: 10.1016/j.injury.2020.02.047. Epub 2020 Feb 11.
The aim of this study was to perform MIPO of the distal tibia from a dorsomedial and dorsolateral approach and to evaluate their feasibility and risk of injury to adjacent anatomical structures.
MATERIAL & METHODS: A total of 18 extremities from 9 adult human cadavers was included in the study. In each cadaver, one lower leg underwent application of a 12-hole 3.5 LCP metaphyseal plate from the medial and the further one from the lateral approach. For the medial approach, a 4 cm skin incision was performed at the tibial border of the Achilles tendon, starting from 1 cm proximal to its insertion point at the calcaneal tuberosity. Entrance was gained between the medial border of the flexor hallucis longus tendon and the medial neurovascular bundle. Regarding the lateral approach, the skin was incised over a length of about 4 cm at the lateral border of the Achilles tendon, approximately 1 cm proximal to its insertion point. Entrance was gained between the Achilles tendon and the peroneus brevis muscle. The plates were inserted in direct bone contact in a proximal direction and the proximal and distal ends were fixed. During dissection, the proximal and distal holes beneath the crossing points of the neurovascular bundle and the plate were noted. The distal and proximal intersection points of the neurovascular bundle and the plate were measured with reference to the distal border of the plate.
Concerning the medial approach, the neurovascular bundle was on median located between the 6th and 11th plate holes starting from distal. The bundle intersected the plate distally at a mean height of 65.8 mm and proximally at 156.8 mm on average. For the lateral approach, the neurovascular bundle was situated between the 6th and the 12th plate hole from distal. It crossed the plate distally at a mean of 61.0 mm and proximal at a mean height of 153.9 mm. In none of the cases, lacerations of the neurovascular bundle were observed.
In conclusion, MIPO from the dorsomedial and dorsolateral approach are both safe procedures as indicated by our study.
本研究的目的是经前内侧和前外侧入路行胫骨远端微创钢板内固定术（MIPO），并评估其对毗邻解剖结构的损伤风险。
本研究共纳入 9 具成人尸体的 18 侧下肢。在每一具尸体中，一条小腿应用内侧和进一步的外侧入路的 12 孔 3.5LCP 干骺端钢板。对于内侧入路，在跟腱胫骨侧做一个 4cm 的皮肤切口，从跟腱止点近端 1cm 处开始。入口位于屈肌长肌腱的内侧缘和内侧神经血管束之间。对于外侧入路，在跟腱外侧做一个大约 4cm 的皮肤切口，在跟腱止点近端约 1cm 处。入口位于跟腱和腓骨短肌之间。钢板以近端方向直接骨接触插入，并固定近端和远端。在解剖过程中，记录神经血管束和钢板交叉处下方的近端和远端孔。以钢板远端边缘为参照，测量神经血管束和钢板的远端和近端交叉点。
对于内侧入路，神经血管束从远端开始，位于第 6 到第 11 个钢板孔的中间。束在远端平均以 65.8mm 的高度与钢板交叉，在近端平均以 156.8mm 的高度与钢板交叉。对于外侧入路，神经血管束位于从远端数第 6 到第 12 个钢板孔之间。它在远端平均以 61.0mm 的高度与钢板交叉，在近端平均以 153.9mm 的高度与钢板交叉。在所有情况下，均未观察到神经血管束的撕裂。
总之，我们的研究表明，经前内侧和前外侧入路行 MIPO 均是安全的手术方法。
