胫骨截骨延长的血管解剖学研究  

VASCULAR ANATOMICAL STUDY ON TIBIAL OSTEOTOMY LENGTHENING

作　　者：王斌[1] 王鹏飞[1] 王宇鹏[1] 贾松[1] 杨焕友[1] 尹佳丽[1] 蒋文平[1] 赵刚[1] 

机构地区：[1]唐山市第二医院(华北理工大学附属骨科医院)手外一科修复重建外科,河北唐山063000

出　　处：《中国修复重建外科杂志》2015年第7期835-839,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的通过对胫骨远、近段血供进行研究,为小腿延长或胫骨骨滑移时选择截骨部位提供解剖学依据。方法 2010年8月-2014年7月,在10侧新鲜成人小腿标本上,经腘动脉加压灌注红色乳胶,分离并暴露胫前动脉及其主要分支,充分显露胫前动脉骨膜分支;暴露胫后动脉及其主要分支;分离暴露腓动脉。对胫前后、腓动脉及其分支进行观察测量。测量时上端以胫骨平台内侧缘（内侧髁上缘）、胫骨粗隆上极、腓骨小头上缘为参照,下端内侧以胫骨内踝尖端、外侧以胫骨外踝尖端、远侧以胫骨下端关节面为参照,测量胫骨远、近段主要供血动脉与骨端参照物的垂直距离,确定胫骨远、近端最佳截骨位置;并计算截骨指数,以表示截骨部位在胫骨全长上的相对位置。结果胫骨近段截骨部位：距离胫骨平台内侧缘（78.2±19.5）mm,距离胫骨粗隆上极（41.8±16.0）mm,距离腓骨小头上缘（66.7±16.4）mm。胫骨远段截骨部位：距离胫骨内踝下缘以上（70.8±12.1）mm,距离外踝尖端下缘以上（83.3±13.0）mm,距离胫骨下端关节面（59.1±11.7）mm。胫骨近段截骨指数为18.45~23.35,平均20.46;胫骨远段截骨指数为14.36~23.05,平均18.81。结论胫骨近段及远段截骨均选择干骺端-骨干连接处,尽量避免在胫骨中下1/3处截骨。Objective To provide the anatomical basis for the selection of osteotomy site in leg lengthening or tibial slip. Methods Between August 2010 and July 2014, 10 adult fresh amputated leg specimens were collected. The pressure perfusion of red latex was performed by the popliteal artery. The anterior tibial artery and its main branches were separated and exposed, and the periosteal branch of anterior tibial artery was adequately exposed; the posterior tibial artery and its main branches were exposed; the peroneal artery was separated and exposed. The tibial and peroneal artery and its branches were observed and measured. When measuring the proximal end, the medial tibial plateau bone margin,the most prominent part of the tibial tuberosity, and the fibular head edge were used as a reference; when measuring the distal end, distal medial condyle of tibia malleolus tip, tibial lateral malleolus lateral tip, and distal tibial articular surface were used as a reference; the vertical distance between tibia proximal and distal main arteries and bone end reference was measured to determine the optimal osteotomy position of upper and lower tibia. The osteotomy index was calculated which was used to represent the relative position of osteotomy site in the whole tibia. Results The proximal tibial osteotomy site located at（78.2±19.5） mm from medial tibial plateau margin,（41.8±16.0） mm from the tibial tuberosity pole, and（66.7±16.4） mm from the fibular head edge. The distal tibial osteotomy site located at（70.8±12.1） mm above the inferior margin of tibial medial malleolus,（83.3±13.0） mm above the inferior margin of lateral malleolus tip, and（59.1±11.7） mm from distal tibial articular surface. The proximal tibial osteotomy index was 18.45-23.35（mean, 20.46）;the distal tibial osteotomy index was 14.36-23.05（mean, 18.81）. Conclusion The metaphyseal-diaphyseal connection shold be selected in the proximal and distal tibia osteotomy, the lower one third of the tibia is not suitable for ostetomy.

关 键 词：截骨延长 ILIZAROV技术 胫骨 解剖 

分 类 号：R687.3[医药卫生—骨科学]