VASCULAR ANATOMICAL STUDY ON TIBIAL OSTEOTOMY LENGTHENING_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANGBin , WANGPengfei , WANGYupeng , JIASong , YANGHuanyou , YINJiali , JIANGWenping , ZHAOGang

No. 1 Department of Hand Surgery, Department of Repair and Reconstruction, the Second Hospital of Tangshan (North China University of Science and Technology Affiliated Orthopedic Hospital), Tangshan Hebei, 063000, P. R. China;

Corresponding?author：

WANGBin, Email: wbladyp3@163.com

Keywords：

Bone lengthening; Ilizarov method; Tibia; Anatomy

DOI：

10.7507/1002-1892.20150181

Video：

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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.

Citation： WANGBin, WANGPengfei, WANGYupeng, JIASong, YANGHuanyou, YINJiali, JIANGWenping, ZHAOGang. VASCULAR ANATOMICAL STUDY ON TIBIAL OSTEOTOMY LENGTHENING. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(7): 835-839. doi: 10.7507/1002-1892.20150181 Copy

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11.	閆敬軍,吳其常,陳振文,等.彈性肢體連續延長器動物實驗.中國矯形外科雜志,1994,1(1):34-36.
12.	夏和桃.肢體延長的基礎進展及臨床有關問題.中國矯形外科雜志,2007,15(8):605-612.
13.	陸維舉,李斌,趙建寧,等.股骨或脛骨滋養動脈結扎對血供的影響.中國矯形外科雜志,2001,8(2):153-155.
14.	曾祥偉,蔣衛平,韋冰丹,等.干骺端潛行截骨延長術矯正肢體短肢畸形.中國修復重建外科雜志,2002,16(2):106-108.
15.	任志勇,徐潭潭,王輝.脛骨遠近端骨膜外截骨延長修復脛骨缺損的臨床X線研究.實用手外科雜志,2014,28(3):247-249,258.
16.	任志勇,李濤,張維彬,等.兔脛骨干骺端骨膜外截骨對延長區成骨作用的影響.中國矯形外科雜志,2015,23(2):150-155.
17.	彭少英,陳藝新,王蘭,等.脛骨下干骺端截骨延長術(附13例報告).貴州醫藥,1987,11(6):4-6.
18.	曲龍.骨搬移治療骨缺損與骨不連Ilizarov技術的臨床應用.北京:人民衛生出版社,2009:14-15.

1. 吳在德,吳肇漢.外科學.北京:人民衛生出版社,2009:792.
2. 秦泗河.Ilizarov技術概述.中華骨科雜志,2006,26(9):642-645.
3. 裴麗霞.脛骨血供的臨床解剖研究.現代預防醫學,2008,35(9):1741-1742,1744.
4. 李起鴻,區伯平,周仲安,等.脛骨干骺端截骨延長術.中華外科雜志,1986,24:109.
5. 王斌,王鵬飛,楊煥友,等.外固定架在膝及小腿血管損傷修復中的應用.中華骨科雜志,2012,32(3):229-234.
6. 韋旭明,孫振中,芮永軍,等.一期縮短二期Ilizarov延長技術治療小腿GustiloⅢC型高能量損傷.中國骨與關節損傷雜志,2013,28(12):1152-1154.
7. 殷渠東,孫振中,顧三軍,等.骨搬運與骨短縮-延長治療脛骨骨缺損合并軟組織缺損的療效比較.中國修復重建外科雜志,2014,28(7):818-822.
8. Gulabi D,Eedem M,Cecen GS,et al.Ilizarov fixator combined with an intramedullary nail for tibial nonunions with bone loss:is it effective? Clin Orthop Relat Res,2014,472(12):3892-3901.
9. 張發惠,劉方剛,鄭和平,等.脛骨上干骺端-骨干截骨延長術的應用解剖.中國臨床解剖雜志,1994,12(1):14-16.
10. 吳其常,張志剛,王春禹,等.脛骨不同部位截骨延長術的療效比較.骨與關節損傷雜志,2003,18(9):602-604.
11. 閆敬軍,吳其常,陳振文,等.彈性肢體連續延長器動物實驗.中國矯形外科雜志,1994,1(1):34-36.
12. 夏和桃.肢體延長的基礎進展及臨床有關問題.中國矯形外科雜志,2007,15(8):605-612.
13. 陸維舉,李斌,趙建寧,等.股骨或脛骨滋養動脈結扎對血供的影響.中國矯形外科雜志,2001,8(2):153-155.
14. 曾祥偉,蔣衛平,韋冰丹,等.干骺端潛行截骨延長術矯正肢體短肢畸形.中國修復重建外科雜志,2002,16(2):106-108.
15. 任志勇,徐潭潭,王輝.脛骨遠近端骨膜外截骨延長修復脛骨缺損的臨床X線研究.實用手外科雜志,2014,28(3):247-249,258.
16. 任志勇,李濤,張維彬,等.兔脛骨干骺端骨膜外截骨對延長區成骨作用的影響.中國矯形外科雜志,2015,23(2):150-155.
17. 彭少英,陳藝新,王蘭,等.脛骨下干骺端截骨延長術(附13例報告).貴州醫藥,1987,11(6):4-6.
18. 曲龍.骨搬移治療骨缺損與骨不連Ilizarov技術的臨床應用.北京:人民衛生出版社,2009:14-15.

Chinese Journal of Reparative and Reconstructive Surgery

VASCULAR ANATOMICAL STUDY ON TIBIAL OSTEOTOMY LENGTHENING

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