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:S27-S31. doi: 10.1016/j.injury.2020.02.051. Epub 2020 Feb 11.
The goal of this study was to evaluate distal femoral minimally invasive plate osteosynthesis (MIPO) from a distal medial approach by use of a pre-bent helical implant.
MATERIAL & METHODS: A total of 18 lower extremities was evaluated. A 29.6 cm steel plate was constructed and pre-bent on bone specimens with a torsion of 55.7° A 5 cm incision was performed from the tip of the medial epicondyle alongside its centre in a proximal direction. The medial border of the vastus medialis was retracted anteriorly. The level of the proximal skin incision was determined using the length of the pre-bent plates. The proximal incision was performed at a length of 4 cm at the described height at a line between the lateral epicondyle and the tip of the greater trochanter. A raspatory was advanced beneath the vastus medialis in a proximal direction to create an extraperiosteal tunnel for plate insertion. The plate was fixed to the bone at its proximal and distal portion via screws. Following dissection, the distance between the nearest perforator to the proximal plate end was evaluated. The vertical distances between the medial border of the plate and the femoral artery and femoral nerve were measured at the level of the proximal plate end and at the level of the proximal margin of the vastoadductor membrane.
The most proximal perforating artery was located at a mean distance of 20.15 mm starting from the proximal plate margin. The mean interval between the medial border of the plate at the level of its proximal tip and the femoral artery was 51.9 mm. The average distance between the femoral nerve and the medial border of the proximal part of the plate was 42.3 mm. Regarding the interval between the medial border of the plate and the femoral artery, this was at a mean of 40.5 mm at the level of the proximal margin of the vastoadductor membrane. During dissection, none of the specimens showed any lesions of the adjacent anatomical characteristics.
Our results indicate MIPO of the distal femur from a medial approach as a safe technique.
本研究的目的是评估经远端内侧入路使用预弯螺旋植入物进行的远端股骨微创接骨板固定术（MIPO）。
共评估了 18 例下肢。在骨标本上构建并预弯了 29.6cm 的钢板，扭转 55.7°。从内侧髁的尖端开始，沿其中心做一个 5cm 的切口向近端延伸。股内侧肌的内侧缘向前牵拉。近端切口的长度根据预弯钢板的长度确定。在描述的高度处，在外侧髁和大转子尖端之间的线的近端，进行 4cm 长的近端切口。用骨锉向近端推进，在股内侧肌下创建一个用于钢板插入的骨膜下隧道。钢板通过螺钉固定在骨的近端和远端部分。解剖后，评估了最接近近端钢板末端的穿支血管之间的距离。测量了近端钢板末端和大收肌腱膜近端边缘水平处钢板内侧缘与股动脉和股神经之间的垂直距离。
最靠近近端钢板边缘的起始处的最接近的穿支动脉位于近端钢板边缘 20.15mm 处。钢板近端尖端水平处钢板内侧缘与股动脉之间的平均间隔为 51.9mm。股神经与钢板近端部分内侧缘之间的平均距离为 42.3mm。关于钢板内侧缘与股动脉之间的间隔，在大收肌腱膜近端边缘水平处平均为 40.5mm。在解剖过程中，没有一个标本显示相邻解剖结构有任何损伤。
我们的结果表明，经内侧入路的远端股骨 MIPO 是一种安全的技术。
