Deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy
Deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy
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DOI：
10.1007/s00167-019-05445-y
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发表时间：
2020-05-01
影响因子：
3.8
通讯作者：
Okazaki, Ken
中科院分区：
文献类型：
--
作者：
Itou, Junya;Itoh, Masafumi;Okazaki, Ken
目的评估胫骨高位楔形截骨术（OWHTO）中远端钻孔置钉对小腿骨间膜神经血管束损伤的风险，并探讨钢板置入方法对该风险的可能影响。方法本回顾性研究涉及2009年至2018年期间接受OWHTO术后膝关节CT扫描的55例患者（32例使用TomoFix钢板，23例使用TriS钢板）。分析锁定钢板的角度和位置，以及螺钉相对于骨间膜的插入方向。结果所有远端螺钉均存在神经血管损伤的风险。特别是，#4孔（45%）的25枚螺钉具有延长的插入轨迹，与骨间膜重叠。TomoFix钢板近端部分的角度是一个显著的风险因素。相比之下，TriS钢板放置方法显示无统计学显著差异。结论：远端螺钉的延长插入轨迹可能与骨间膜相交，神经血管束可能在其表面上;因此，双皮质固定钻孔有神经血管损伤的风险。随着TomoFix接骨板放置在更内侧，风险增加，这表明当接骨板放置在内侧位置时，必须非常注意进行双皮质钻孔。考虑到#3和#4螺钉孔的风险特别高，只要确保良好的稳定性，建议使用少量远端螺钉进行单皮质固定。
Purpose To assess the risk of injury to the neurovascular bundle on the interosseous membrane of the leg during drilling for distal screw insertion in open-wedge high tibial osteotomy (OWHTO), and to investigate the possible influence of the method of plate placement on the risk. Methods This retrospective study involved, 55 patients (32 with a TomoFix plate, 23 with a TriS plate) who underwent postoperative CT scanning of the knee following OWHTO between 2009 and 2018. The angle and position of the locking plate, and the direction of screw insertion relative to the interosseous membrane were analysed. Results All distal screws had a risk of neurovascular injury. In particular, 25 screws at the #4 hole (45%) had an extended insertion trajectory that intersected with the interosseous membrane. The angle of the proximal part of the TomoFix plate was a significant risk factor. In contrast, methods of TriS plate placement showed no statistically significant differences. Conclusions Extended insertion trajectories of distal screws were likely to intersect with the interosseous membrane with the neurovascular bundle potentially on its surface; thus, drilling for bicortical fixation posed a risk of neurovascular injury. The risk increased as the TomoFix plate was placed more medially, suggesting that bicortical drilling must be performed with the utmost attention when the plate is placed at the medial position. Given the particularly high risk at the #3 and #4 screw holes, monocortical fixation of a few distal screws is recommended as long as good stability is ensured.