Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Antalya, Turkey.
Vocational School of Health Services, Akdeniz University, Antalya, Turkey.
J Knee Surg. 2022 Jun;35(7):725-730. doi: 10.1055/s-0040-1716849. Epub 2020 Oct 30.
The anterior tibial artery (ATA) is the most critical anatomical structure at risk at the distal border of the posterolateral approach to the tibial plateau. This study aimed to use available lower extremity digital subtraction angiography (DSA) images to determine the distal safe limit of this approach by measuring the distance from the tibial joint line to the ATA where it pierces the interosseous membrane. Tibial plateau mediolateral width (TP-ML-W) and the perpendicular distances from the ATA to the tibial joint line and fibular head were measured on DSA images in 219 lower extremities. To normalize the distances according to the tibial dimensions, each distance was divided by the TP-ML-W, and a ratio was obtained. Popliteal artery branching pattern was categorized according to the classification proposed by Kim et al. Comparative analysis between right and left extremities, genders, and anatomical variations were performed. There were 102 male and 26 female subjects with a mean age of 60.7 ± 15.7 years (range, 17-92 years). Ninety-one subjects had bilateral lower extremity DSA; thus, a total of 219 extremities were analyzed. The TP-ML-W was wider in male (78.3 ± 7.0) than female (70.5 ± 7.3) subjects ( = 0.001). The ATA coursed through the interosseous membrane at 50.9 ± 6.9 mm (range, 37.4-70.2 mm) distal to the tibial plateau joint line, and it was 66.5 ± 7.2% of the TP-ML-W. The ATA coursed through the interosseous membrane at 36.5 ± 6.0 mm (range, 21.9-53.8 mm) distal to the fibular head, and it was 47.7 ± 6.6% of the TP-ML-W. All measured variables were similar between the regular branching pattern of the popliteal artery (type 1A) and other observed variations among male subjects. The safe length of dissection in the posterolateral approach is average 66.5% (range, 45.7-86.7%) of the TP-ML-W. This ratio is valid for both genders. The use of a ratio instead of a distance, which is subject to personal variations, seems to be more logical and practical for planning this surgery, but the wide range should still not be ignored.
胫骨前动脉（ATA）是胫骨平台后外侧入路远端边界处最危险的解剖结构。本研究旨在利用现有的下肢数字减影血管造影（DSA）图像，通过测量 ATA 穿过骨间膜处到胫骨关节线的距离，来确定该入路的远端安全界限。在 219 例下肢 DSA 图像上测量胫骨平台内外径（TP-ML-W）以及 ATA 到胫骨关节线和腓骨头的垂直距离。为了根据胫骨尺寸对距离进行归一化，将每个距离除以 TP-ML-W 并获得比值。腘动脉分支模式根据 Kim 等人提出的分类进行分类。对右、左下肢，性别和解剖变异进行了比较分析。共有 102 例男性和 26 例女性，平均年龄为 60.7±15.7 岁（范围 17-92 岁）。91 例患者进行了双侧下肢 DSA，因此共分析了 219 例下肢。男性的 TP-ML-W 较女性（78.3±7.0 比 70.5±7.3）更宽（ = 0.001）。ATA 在胫骨关节线远端 50.9±6.9mm（范围 37.4-70.2mm）处穿过骨间膜，占 TP-ML-W 的 66.5%。ATA 在腓骨头远端 36.5±6.0mm（范围 21.9-53.8mm）处穿过骨间膜，占 TP-ML-W 的 47.7%。在男性中，腘动脉的常规分支模式（1A 型）与观察到的其他变异之间的所有测量变量均相似。后外侧入路的安全分离长度平均为 TP-ML-W 的 66.5%（范围 45.7-86.7%）。这个比值对男女都适用。与距离相比，使用比值（不受个人差异影响）似乎更符合逻辑和实际，有助于规划这种手术，但仍不应忽视较大的范围。
