Chen Yu-Sheng, Yang Chyun-Yu, Chang Chih-Wei, Chen Yen-Nien
Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Orthopedics, Kuo General Hospital, Tainan, Taiwan.
Patient Saf Surg. 2022 Jul 30;16(1):25. doi: 10.1186/s13037-022-00334-9.
Partial fibular osteotomy has been recognized as a surgical alternative to treat medial compartment osteoarthritis of the knee. Related peroneal neuropathies are of concern among the relatively few complications after this procedure. In our clinical practice, the osteotomy level has therefore been modified to avoid the above defects. However, a rare case of vascular injury was encountered. Herein we describe an accidental anterior tibial artery pseudoaneurysm as a rare technical complication after this corrective osteotomy.
A 55-year-old male visited our emergency room, presenting a painful swelling over his right anterolateral shin along with surrounding ecchymosis. Thirteen days ago, he just underwent a corrective fibular osteotomy over his right painful varus knee at our institute, and was discharged after an uneventful postoperative stay. Urgent angiography revealed an out-pouching vascular lesion, pseudoaneurysm, involving his right anterior tibial artery. Prompt endovascular repair with stent insertion and balloon compression successfully stopped the persistent extravasation from the injured artery. Follow-up angiography as well as outpatient review confirmed the regression of this lesion and associated symptoms without sequelae.
Although corrective fibular osteotomy is a simple surgical procedure, it is not free of complications. The suggested osteotomized level in the pertinent literature predisposes patients to certain neuromuscular deficits, which could be avoided by the modified level of osteotomy. However, our case highlights surgeons' familiarity with certain risky neurovascular structures around the osteotomy site and corresponding technical considerations. A recent surgical history along with alarming symptoms/signs should arouse clinical suspicion, aid in timely identification and make appropriate interventions for potential vascular complications.
腓骨部分截骨术已被公认为治疗膝关节内侧间室骨关节炎的一种手术替代方法。相关的腓总神经病变是该手术后相对较少的并发症之一，值得关注。在我们的临床实践中，因此对截骨水平进行了调整以避免上述缺陷。然而，我们遇到了一例罕见的血管损伤病例。在此，我们描述一例意外的胫前动脉假性动脉瘤，这是这种矫正性截骨术后罕见的技术并发症。
一名55岁男性就诊于我们的急诊室，其右小腿前外侧出现疼痛性肿胀并伴有周围瘀斑。13天前，他刚刚在我们医院接受了针对其右膝疼痛性内翻的矫正性腓骨截骨术，术后恢复顺利并出院。紧急血管造影显示一个向外膨出的血管病变，即假性动脉瘤，累及他的右胫前动脉。通过及时进行支架置入和球囊压迫的血管内修复成功阻止了受伤动脉的持续渗血。随访血管造影以及门诊复查证实该病变及相关症状消退，无后遗症。
尽管矫正性腓骨截骨术是一种简单的外科手术，但并非没有并发症。相关文献中建议的截骨水平使患者易出现某些神经肌肉缺陷，而通过调整截骨水平可以避免这些缺陷。然而，我们的病例强调了外科医生对截骨部位周围某些危险神经血管结构的熟悉程度以及相应的技术考量。近期的手术史以及警示症状/体征应引起临床怀疑，有助于及时识别并对潜在的血管并发症做出适当干预。
