Rupp R E, Podeszwa D, Ebraheim N A
Department of Orthopaedic Surgery, Medical College of Ohio, Toledo 43699.
J Orthop Trauma. 1994;8(1):54-8. doi: 10.1097/00005131-199402000-00012.
Anatomic dissections were performed on five cadaveric lower extremities. Measurements of important neurovascular structures in relation to the fibula were obtained at 1-cm intervals along the length of the fibula with the tip of the fibular head as the reference point. Neurovascular structures adjacent to the fibula in danger of injury with fibular osteotomy were identified. At the proximal one-third of the fibula, the peroneal nerves and their muscular branches are at primary risk. The anterior tibial artery is vulnerable where it penetrates the interosseous membrane and where it runs adjacent to the fibula with the deep peroneal nerve. In the middle one-third of the fibula, the peroneal artery and vein are the major structures at risk. In the distal one-third of the fibula the peroneal vessels are at less risk because they branch and enter the region of the syndesmosis curving anteriorly. The other neurovascular structures are not adjacent to the fibula. Based on these data, general recommendations for fibular osteotomy include (a) placement of the osteotomy as distally along the shaft as is feasible, commensurate with the surgical goal; (b) direction of the osteotomy blade along a line connecting the axis of the fibula with the midpoint of the subcutaneous tibial surface in the proximal and middle one-third of the fibula; and (c) direction of the osteotomy blade from the axis of fibula to the anterior subcutaneous border of the tibia in the distal one-third of the fibula.
对五具尸体的下肢进行了解剖。以腓骨头尖端为参考点，沿腓骨长度每隔1厘米测量与腓骨相关的重要神经血管结构。确定了在腓骨截骨术中有受伤风险的毗邻腓骨的神经血管结构。在腓骨近端三分之一处，腓总神经及其肌支面临主要风险。胫前动脉在穿过骨间膜处以及与腓深神经一起毗邻腓骨走行处易受损伤。在腓骨中三分之一处，腓动脉和静脉是主要的风险结构。在腓骨远端三分之一处，腓血管风险较小，因为它们分支并进入向前弯曲的下胫腓联合区域。其他神经血管结构不毗邻腓骨。基于这些数据，腓骨截骨术的一般建议包括：(a) 在可行的情况下，将截骨术尽可能置于骨干远端，与手术目标相称；(b) 在腓骨近端和中三分之一处，截骨刀片的方向沿连接腓骨轴线与胫骨皮下表面中点的连线；(c) 在腓骨远端三分之一处，截骨刀片的方向从腓骨轴线指向胫骨前皮下边界。
