O'Leary Brendan, Mitchell Brendon, Thomas Sean, Onodera Keenan, Huang Brady, Kent William T
Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA.
University of California San Diego School of Medicine, La Jolla, CA; and.
J Orthop Trauma. 2024 Jan 1;38(1):e15-e19. doi: 10.1097/BOT.0000000000002718.
The objective of this study was to define the danger zone at which the anterior tibial artery (ATA) is at risk during anterolateral plating of the distal tibia using a novel 3D computed tomography angiography (CTA) modeling technique.
116 patients (232 lower extremities) who underwent lower extremity CTAs between April 2020 and April 2022 were identified. Those with lower extremity trauma, evidence of a previously healed tibial fracture, or poor visualization of the ATA were excluded. The remaining 150 lower extremities (92 patients) were modeled with an anterolateral distal tibia plate using Sectra IDS7 software. The distance of the ATA from bony landmarks was measured perpendicular to the level at which the vessel intersected the plate.
The ATA intersected the plate proximally at a mean distance of 10.5 cm (95% confidence intervals, 10.2-10.9) and at a mean distance of 4.6 cm (95% confidence intervals, 4.4-4.9) distally from the central tibial plafond. The ATA intersected with the plate as far distal as hole number 1 and as proximal as hole 14 of the plate. The greatest injury risk was associated with plate holes 3-8. In this region, the artery was at risk in 46-99 percent of specimens.
The ATA is at risk when screws are placed percutaneously in an anterolateral distal tibia plate. The artery can be as close as 4.4 cm and as far as 10.9 cm proximal to the tibial plafond when crossing the plate, correlating to a risk of injury to the ATA at plate holes 1 through 14.
本研究的目的是使用一种新型的三维计算机断层扫描血管造影（CTA）建模技术，确定在胫骨远端前外侧钢板固定过程中胫前动脉（ATA）处于危险的区域。
确定了2020年4月至2022年4月期间接受下肢CTA检查的116例患者（232条下肢）。排除有下肢创伤、既往胫骨骨折已愈合的证据或ATA显示不佳的患者。使用Sectra IDS7软件对其余150条下肢（92例患者）进行胫骨远端前外侧钢板建模。测量ATA与骨标志的距离，该距离垂直于血管与钢板相交的水平。
ATA在钢板近端与钢板相交处距胫骨平台中央的平均距离为10.5 cm（95%置信区间，10.2 - 10.9），在钢板远端与钢板相交处距胫骨平台中央的平均距离为4.6 cm（95%置信区间，4.4 - 4.9）。ATA与钢板相交的最远端为钢板的第1孔，最近端为第14孔。最大的损伤风险与钢板的第3 - 8孔相关。在该区域，46% - 99%的标本中的动脉处于危险中。
当经皮在胫骨远端前外侧钢板上置入螺钉时，ATA处于危险中。动脉在穿过钢板时距胫骨平台近端最近可达4.4 cm，最远可达10.9 cm，这与ATA在钢板第1至14孔处受伤的风险相关。
