Rubash H E, Berger R A, Britton C A, Nettrour W S, Seel M J
Department of Orthopaedic Surgery, University of Pittsburgh, Pennsylvania.
Clin Orthop Relat Res. 1993 Jan(286):56-63.
This investigation determined the position of neurologic and vascular structures at risk during screw fixation of an uncemented tibial component in total knee arthroplasty relative to the cut surface of the tibial plateau. Sixteen anatomic specimens of the lower extremities were studied by systematically placing screws about the tibial plateau followed by computed tomographic scanning with three-dimensional reconstruction and anatomic dissection. The structures at risk during screw preparation and placement were the tibial nerve, popliteal artery, popliteal vein, anterior tibial artery, and common peroneal nerve with its superficial and deep branches. The application of a clock system to the cut surface of the tibial plateau with the six o'clock position defined as directly anterior and the three o'clock position defined as lateral identified the entire region between the 11 o'clock and three o'clock positions as a location where potential injury to vital structures can occur during screw placement. The risk of injury to these structures may be minimized by directing screws radially inward to avoid violation of the tibial cortex. Any penetration of the cortex between the 11 o'clock and three o'clock positions may have potentially devastating consequences because of the close proximity of neurologic and vascular structures.
本研究确定了全膝关节置换术中非骨水泥型胫骨假体螺钉固定过程中，有风险的神经和血管结构相对于胫骨平台截骨面的位置。通过在胫骨平台周围系统地置入螺钉，随后进行计算机断层扫描三维重建和解剖 dissection，对 16 个下肢解剖标本进行了研究。螺钉准备和置入过程中有风险的结构包括胫神经、腘动脉、腘静脉、胫前动脉以及腓总神经及其浅支和深支。将时钟系统应用于胫骨平台截骨面，将 6 点钟位置定义为正前方，3 点钟位置定义为外侧，确定 11 点钟和 3 点钟位置之间的整个区域是螺钉置入过程中可能对重要结构造成潜在损伤的部位。通过将螺钉径向向内置入以避免穿透胫骨皮质，可将这些结构受损的风险降至最低。由于神经和血管结构距离很近，在 11 点钟和 3 点钟位置之间的皮质任何穿透都可能产生潜在的灾难性后果。 （注：原文中“anatomic dissection”直译为“解剖解剖”有误，可能是“解剖分离”之类的意思，但结合语境此处存疑，暂保留原文。）
