本文選題：組織工程　切入點(diǎn)：脛骨　出處：《中國(guó)組織工程研究》2015年53期 　論文類型：期刊論文

【摘要】：背景:有研究表明脛骨平臺(tái)后外側(cè)骨折可以通過(guò)膝關(guān)節(jié)后外側(cè)入路進(jìn)行處理,但尚無(wú)明確的解剖學(xué)研究對(duì)此入路進(jìn)行深入的評(píng)估和分析。目的:評(píng)估膝關(guān)節(jié)后外側(cè)倒"L"形徑路在累及脛骨平臺(tái)后外側(cè)骨折治療中的安全性及有效性。方法:新鮮冰凍成人尸體8具,雙膝16側(cè)。均行后外側(cè)倒"L"形徑路解剖。解剖中觀察顯露范圍,并測(cè)量重要解剖結(jié)構(gòu)參數(shù)。結(jié)果與結(jié)論:該徑路可以充分暴露平臺(tái)后外側(cè)、后交叉韌帶脛骨止點(diǎn)等。作者團(tuán)隊(duì)在操作上對(duì)上脛腓關(guān)節(jié)、腓骨頭及膝關(guān)節(jié)后外側(cè)角結(jié)構(gòu)無(wú)明顯干擾。腓總神經(jīng)在切口內(nèi)暴露長(zhǎng)度平均為56.48 mm,與腓骨軸成平均14.7°傾斜。其繞腓骨頸處距腓骨頭尖平均為31.26 mm,距關(guān)節(jié)線的平均為42.18 mm。骨間膜裂孔距關(guān)節(jié)面距離平均為48.78 mm。腓動(dòng)脈自脛后動(dòng)脈發(fā)出點(diǎn)距關(guān)節(jié)面平均為76.46 mm。結(jié)果證實(shí),經(jīng)解剖學(xué)證實(shí)后外側(cè)倒"L"形徑路能夠滿足后外側(cè)骨折解剖復(fù)位支撐固定的需要,通過(guò)改良皮膚切口可以減少甚至避免對(duì)腓總神經(jīng)暴露。由于有乆動(dòng)脈分支脛前動(dòng)脈穿越骨間膜裂孔及腓動(dòng)脈自脛后動(dòng)脈分出,徑路向遠(yuǎn)側(cè)深部剝離時(shí)需小心進(jìn)行,放置支撐鋼板時(shí)可能穿越血管下方,有一定風(fēng)險(xiǎn)。
[Abstract]:Background: studies have shown that fractures of the posterolateral tibial plateau can be managed through the posterolateral approach of the knee joint. However, there is no definite anatomical study to evaluate and analyze this approach. Objective: to evaluate the safety and efficacy of posterolateral "L" approach in the treatment of posterolateral tibial plateau fractures. 8 fresh frozen adult bodies, 16 knees were dissected with the anterolateral "L" approach. The exposed area was observed and important anatomical parameters were measured. Results and conclusions: the posterior lateral of the platform can be fully exposed by this approach. Posterior cruciate ligament tibial insertion and so on. The length of the common peroneal nerve exposed in the incision was 56.48 mm, which was inclined to the fibula axis on average 14.7 擄. The average length of the peroneal nerve around the fibula neck was 31.26 mm from the fibula head tip and the average line of the talus joint. The distance from the interosseous membrane fissure to the articular surface was 48.78 mm. the average distance from the posterior tibial artery to the articular surface of the peroneal artery was 76.46 mm. Anatomically proved that the retrograde "L" path of posterolateral fracture can meet the need of anatomical reduction and fixation of posterolateral fracture. Exposure to the common peroneal nerve can be reduced or even avoided through a modified skin incision. Since there are some branches of the anterior tibial artery that pass through the interosseous hiatus and the peroneal artery is separated from the posterior tibial artery, the path to the distal depth should be carefully dissected. Placement of the support plate may be through the blood vessel below, there is a certain risk.
【作者單位】： 江蘇省海門市人民醫(yī)院骨科;上海交通大學(xué)附屬第六人民醫(yī)院骨科;
【基金】：上海同濟(jì)大學(xué)解剖學(xué)教研室對(duì)實(shí)驗(yàn)的的支持和專業(yè)指導(dǎo)
【分類號(hào)】：R687;R322.7

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