CAJ | 학술논문

目的为治疗胫骨平台后柱骨折的膝关节后侧倒L入路提供解剖学基础。方法①选取福尔马林固定的教学用成人下肢标本32例。解剖并观测与膝关节后侧倒L入路相关的重要神经、血管、肌肉及韧带的走行和分布特点。②选取新鲜成人下肢标本4例，按照预先设计的膝关节后侧倒L入路进行模拟手术，观察该入路的可行性。结果应用膝关节后侧倒L入路不需要显露胫后神经和腘动静脉；可以经腘肌下面显露胫骨平台的后内侧及后外侧部，在显露胫骨平台后外侧部时腘神经血管束可以通过腘肌和腓肠肌内侧头得到保护；胫前动脉穿骨间膜处位于胫骨平台下方男：(59.44±3.97)mm、女：(58.67±1.37)mm。距离胫骨后内缘的距离男：(38.72±3.54)mm、女：(39.12±4.05)mm。在向外侧剥离腘肌时胫前动脉在穿骨间膜处易受损伤，但如果在骨膜下剥离并不超过胫骨后外缘可避免损伤胫前动脉。结论膝关节后侧倒“L”入路操作简单、安全，可以在临床上推广使用。
목적위치료경골평태후주골절적슬관절후측도L입로제공해부학기출。방법①선취복이마림고정적교학용성인하지표본32례。해부병관측여슬관절후측도L입로상관적중요신경、혈관、기육급인대적주행화분포특점。②선취신선성인하지표본4례，안조예선설계적슬관절후측도L입로진행모의수술，관찰해입로적가행성。결과응용슬관절후측도L입로불수요현로경후신경화객동정맥；가이경객기하면현로경골평태적후내측급후외측부，재현로경골평태후외측부시객신경혈관속가이통과객기화비장기내측두득도보호；경전동맥천골간막처위우경골평태하방남：(59.44±3.97)mm、녀：(58.67±1.37)mm。거리경골후내연적거리남：(38.72±3.54)mm、녀：(39.12±4.05)mm。재향외측박리객기시경전동맥재천골간막처역수손상，단여과재골막하박리병불초과경골후외연가피면손상경전동맥。결론슬관절후측도“L”입로조작간단、안전，가이재림상상추엄사용。
Objective To provide anatomic basis for treatment of the posterior column fractures of tibial plateau by posterior reversed L-shaped approach. Methods The main vessels,nerves,muscles and ligaments relative to the posterior reversed L-shaped approach were observed and measured on 32 cases of lower limbs of the adult cadavers chosed.To make sure the practicality of the posterior reversed L-shaped approach,surgical simulation were performed on anther 4 lower limbs of fresh adult cadavers.Results The operative incision of this approach don't need to expose the posterior tibial nerve or popliteal artery,it is revealed posterormedial and posterorlateral of tibia platform by lower edge of the popliteus.While revealing the posterolateral platform,popliteal neurovascular bundle can be protect by popliteus and medial head of the gastrocnemius muscle,The distance between lower edge of tibia platform and tibial artery which pass through interosseous membrane is:(59.44±3.97)mm for male,(58.67± 1.37)mm for female.The distance between posterior medial edge and tibial airery which pass through interosseous membrane:(38.72±3.54)mm for male,(36.93±1.88)mm for female.It was Easy to damage it when stripping popliteus outwardl.but stripping under the periosteum which is not go over posterior tibial can avoid damaging.Conclusion Confirmed by anatomical study:posterior reversed L-shaped approach is relatively simple and safe,and it can be widely used in clinic to treat the posterior column fractures of tibial plateau.