Kalhor Morteza, Elahifar Omid, Eslami Arvin, Gharehdaghi Jaber
Department of Orthopaedic Surgery, Iran University of Medical Sciences, Firoozgar Medical Center, Tehran, Iran.
Legal Medicine Research Center, Iran Legal Medicine Organization, Tehran, Iran.
Bone Joint Res. 2025 Sep 3;14(9):769-776. doi: 10.1302/2046-3758.149.BJR-2024-0547.R2.
The significance of periosteal vessels in the healing of tibial shaft fractures is well-established. However, the gross anatomical patterns and differential distribution of these vessels on the medial versus lateral surface of the tibial shaft have not been thoroughly described. This study aimed to illustrate the comparative anatomy of periosteal circulation on the medial versus lateral surface of the tibial shaft, where tibial plates are commonly applied.
Ten adult fresh cadavers underwent aortic injection with coloured silicone to investigate the vascular system of the lower limbs, including the tibial extraosseous circulation. Following material fixation, the medial and lateral tibial surfaces were dissected extraperiosteally from the knee to the ankle joint to visualize the gross anatomy of periosteal vessels running along the medial and lateral surfaces of the tibial shaft.
In all specimens, periosteal vessels on the lateral tibial consisted of six to eight main trunks in 17 out of 20 specimens. These vessels were evenly distributed, horizontally oriented, and exhibited variable side branching. Most of these vessels crossed the anterior tibial crest, terminating on the medial side. The extensor muscles on the lateral tibial surface made negligible contributions to the periosteal circulation. The medial tibial surface received its periosteal blood supply partly from the terminal branches of the traversing vessels from the lateral surface and partly from branches of the posterior tibial artery. These vessels were shorter, smaller, sparsely scattered, randomly distributed, and exhibited greater variability in number and size compared to their lateral counterparts.
Periosteal circulation to the anterior two-thirds of the tibial shaft is mainly delivered through the lateral tibial surface. When periosteal circulation is a concern, lateral plating may be more disruptive compared to medial plating.
骨膜血管在胫骨干骨折愈合中的重要性已得到充分证实。然而，这些血管在胫骨干内侧与外侧表面的大体解剖模式及差异分布尚未得到详尽描述。本研究旨在阐明胫骨干内侧与外侧表面骨膜循环的比较解剖结构，胫骨干内侧与外侧表面是常用胫骨钢板的应用部位。
对10具成年新鲜尸体的主动脉注入彩色硅胶，以研究下肢血管系统，包括胫骨骨外循环。材料固定后，从膝关节至踝关节在骨膜外解剖胫骨内侧和外侧表面，以观察沿胫骨干内侧和外侧表面走行的骨膜血管的大体解剖结构。
在所有标本中，20个标本中有17个标本的胫骨外侧骨膜血管由6至8条主干组成。这些血管分布均匀，呈水平方向，并有不同的侧支分支。这些血管大多穿过胫骨前缘，止于内侧。胫骨外侧表面的伸肌对骨膜循环的贡献可忽略不计。胫骨内侧表面的骨膜血供部分来自外侧表面横行血管的终末分支，部分来自胫后动脉分支。与外侧血管相比，这些血管较短、较细，分布稀疏、随机，数量和大小的变异性更大。
胫骨干前三分之二的骨膜循环主要通过胫骨外侧表面提供。当关注骨膜循环时，与内侧钢板固定相比，外侧钢板固定可能对骨膜循环破坏更大。
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