Mori Akiyoshi, Matsushita Takehiko, Miyaji Nobuaki, Nagai Kanto, Araki Daisuke, Kanzaki Noriyuki, Matsumoto Tomoyuki, Niikura Takahiro, Hoshino Yuichi, Kuroda Ryosuke
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Knee Surg Relat Res. 2022 May 8;34(1):25. doi: 10.1186/s43019-022-00154-2.
Our objective was to evaluate the location of popliteal artery (PA) in osteotomy planes during high tibial osteotomy (HTO) and to determine a safer angle for screw drilling to the tibial tuberosity during distal tuberosity osteotomy (DTO).
Twenty knees in 20 patients who underwent contrast-enhanced computed tomography for cardiovascular diseases were examined. Osteotomy planes for open-wedge HTO (OWHTO) and hybrid closed-wedge HTO (hybrid CWHTO) were created using three-dimensional bone models. The distance from the posterior cortex of the tibia to the PA (dPC-PA) in the osteotomy planes was measured in the virtual osteotomy planes. The dangerous point (Point D1) was defined as the point 17.5 mm away from PA, setting the working length of the bone saw as 35 mm. The distance between the most medial point of the tibial cortex (Point M) and Point D1 in OWHTO and the most lateral point (Point L) and Point D1 in hybrid CWHTO were examined (dM-D1 and dL-D1, respectively). The location of Point D1 to the osteotomy line (%D1) was expressed as percentage, setting the start and end of the osteotomy line as 0% and 100%, respectively. To determine the safe angle for screw drilling in DTO, the angle between the line tangential to the medial cortex of the tibia and that passing through the center of the tibial tuberosity and PA were measured.
In OWHTO and hybrid CWHTO, the mean dPC-PA was 10.6 mm (6.9-16.5 mm) and 10.2 mm (7.3-15.4 mm), respectively. The mean dM-D1 in OWHTO was 25.9 mm (24.6-27.2 mm) and dL-D1 in hybrid CWHTO was 5.1 mm (2.9-7.4 mm). The mean %D1 was 47.6 ± 3.7% in OWHTO and 9.3 ± 4.1% in hybrid CWHTO, respectively. The minimal angle between the two lines in DTO was 35.2°.
PAs could run within 10 mm from the posterior cortex in the osteotomy planes of HTO. Therefore, proper posterior protection is necessary when cutting posterior cortex. An angle of less than 35° against the medial cortex line would be safe for screw fixation to avoid vascular injury in DTO.
我们的目的是评估高位胫骨截骨术（HTO）过程中腘动脉（PA）在截骨平面中的位置，并确定在远端结节截骨术（DTO）期间向胫骨结节钻孔的更安全角度。
对20例因心血管疾病接受对比增强计算机断层扫描的患者的20个膝关节进行检查。使用三维骨模型创建开放楔形HTO（OWHTO）和混合闭合楔形HTO（混合CWHTO）的截骨平面。在虚拟截骨平面中测量胫骨后皮质到PA的距离（dPC-PA）。危险点（点D1）定义为距离PA 17.5毫米的点，将骨锯的工作长度设定为35毫米。检查OWHTO中胫骨皮质最内侧点（点M）与点D1之间的距离以及混合CWHTO中最外侧点（点L）与点D1之间的距离（分别为dM-D1和dL-D1）。点D1到截骨线的位置（%D1）以百分比表示，将截骨线的起点和终点分别设定为0%和100%。为了确定DTO中钻孔的安全角度，测量胫骨内侧皮质切线与穿过胫骨结节中心和PA的线之间的角度。
在OWHTO和混合CWHTO中，平均dPC-PA分别为10.6毫米（6.9 - 16.5毫米）和10.2毫米（7.3 - 15.4毫米）。OWHTO中的平均dM-D1为25.9毫米（24.6 - 27.2毫米），混合CWHTO中的平均dL-D1为5.1毫米（2.9 - 7.4毫米）。OWHTO中的平均%D1分别为47.6±3.7%，混合CWHTO中的平均%D1为9.3±4.1%。DTO中两条线之间的最小角度为35.2°。
在HTO的截骨平面中，PA可能在距后皮质10毫米范围内走行。因此，在切割后皮质时需要适当的后方保护。在DTO中，与内侧皮质线成小于35°的角度进行螺钉固定是安全的，可避免血管损伤。
