CAJ | 학술논문

目的探讨全膝关节置换术中腘血管损伤的危险区域.方法回顾性分析2012年5至12月拍摄的1 291例膝关节MRI片,男564例,女727例;年龄16～ 87岁,中位年龄37岁;右侧565例,左侧726例.在横断位MRI片上测量膝关节髁上连线水平腘动脉与股骨外侧髁的最短距离(PA-LFC)、关节线水平腘动脉与后关节囊的距离(PA-PC)、关节线以下10 mm水平腘动脉与胫骨后方皮质的距离(PA-PTC);在矢状位MRI片上测量腘动脉与胫骨后方皮质的最短距离(PA-PTCs)及腘动脉与后十字韧带的内外侧关系.取6具新鲜冰冻尸体膝关节标本,明确腘动脉的位置,测量其与膝关节囊及腘肌的距离.结果 1 291例膝关节MRI中出现腘动脉高位分叉变异17例(1.32％,17/1 291).PA-LFC、PA-PC、PA-PTC及PA-PTCs分别为(4.89± 1.80)mm、(4.05±1,43) mm、(3,61±1,39) mm及(3.58±1.04) mm.膝关节积液增加PA-LFC和PA-PC的数值,但不增加PA-PTC和PA-PTCs的数值.腘动脉总是位于血管神经束最前方.在关节线水平,腘动脉均位于后十字韧带内缘的外侧.尸体解剖显示膝关节线距腘肌上缘(1.13±0.23) cm,该段腘动脉及其分支构成一个三角形区域,紧贴关节囊和胫骨皮质,三角形后方为腘动脉主干、膝外下动脉、膝正中动脉等密集分布的区域.结论腘动脉损伤危险三角形区域后方存在重要的缺乏足够软组织保护的血管,包括腘动脉、膝外下动脉、膝正中动脉及一些无名小动脉,在全膝关节置换术中应注意保护.
목적 탐토전슬관절치환술중객혈관손상적위험구역.방법 회고성분석2012년5지12월박섭적1 291례슬관절MRI편,남564례,녀727례;년령16～ 87세,중위년령37세;우측565례,좌측726례.재횡단위MRI편상측량슬관절과상련선수평객동맥여고골외측과적최단거리(PA-LFC)、관절선수평객동맥여후관절낭적거리(PA-PC)、관절선이하10 mm수평객동맥여경골후방피질적거리(PA-PTC);재시상위MRI편상측량객동맥여경골후방피질적최단거리(PA-PTCs)급객동맥여후십자인대적내외측관계.취6구신선빙동시체슬관절표본,명학객동맥적위치,측량기여슬관절낭급객기적거리.결과 1 291례슬관절MRI중출현객동맥고위분차변이17례(1.32％,17/1 291).PA-LFC、PA-PC、PA-PTC급PA-PTCs분별위(4.89± 1.80)mm、(4.05±1,43) mm、(3,61±1,39) mm급(3.58±1.04) mm.슬관절적액증가PA-LFC화PA-PC적수치,단불증가PA-PTC화PA-PTCs적수치.객동맥총시위우혈관신경속최전방.재관절선수평,객동맥균위우후십자인대내연적외측.시체해부현시슬관절선거객기상연(1.13±0.23) cm,해단객동맥급기분지구성일개삼각형구역,긴첩관절낭화경골피질,삼각형후방위객동맥주간、슬외하동맥、슬정중동맥등밀집분포적구역.결론 객동맥손상위험삼각형구역후방존재중요적결핍족구연조직보호적혈관,포괄객동맥、슬외하동맥、슬정중동맥급일사무명소동맥,재전슬관절치환술중응주의보호.
Objective To investigate the anatomical dangerous region of popliteal vascular injury in total knee arthroplasty (TKA).Methods The retrospective data of 1 291 consecutive MRI of knees was collected,with 565 right knees and 726 left knees,727 women and 564 men.The patients's age ranged from 16 to 87 years with a median age of 37 years.The distances between the popliteal artery and lateral femoral condyle at the epicondylar level (PA-LFC),between the popliteal artery and the posterior capsule at the joint line level (PA-PC),between the popoliteal artery and posterior tibial cortex at the level of 10 mm below the joint line (PA-PTC) and the shortest distance between the poplitealartery and posterior tibial cortex in the sagital plane (PA-PTCs) were measured.The location of popliteal artery relative to posterior cruciate ligament was documented.Six fresh frozen cadaver knees were dissected to delineate the location of popliteal artery and measure the distances between popliteal artery and both knee capsule and popliteal muscle.Results Seventeen knees among 1 291 knees (1.32％,17/1 291) showed the aberrant high origin of anterior tibial artery.The values of PA-LFC,PA-PC,PA-PTC and PA-PTCs were 4.89± 1.80 mm,4.05± 1.43 mm,3.61±1.39 mm and 3.58±1.04 mm.The effusion of knees helped to increase PA-LFC and PA-PC but not PA-PTC or PA-PTCs.The popliteal artery laid anteriorly in the vessel bundle and it was located laterally to the medial border of posterior cruciate ligament at the joint line level.The cadaveric study showed a distance of 1.13±0.23 cm between joint line and superior border of popliteal muscle where the popliteal artery went very close to knee capsule and tibia cortex.There was an anatomical triangle accommodating popliteal artery,inferior lateral geniculate artery,middle geniculate artery and several unnamed small arteries.Conclusion When performing a total knee arthroplasty,we should pay attention to an anatomical triangle where the popliteal vessels including popliteal artery,inferior lateral geniculate artery,middle geniculate artery and several unnamed small arteries are significantly lack of protection of adequate soft tissues.