Distance Between the Anterior Distal Tibial Edge and the Anterior Tibial Artery in Distraction and Nondistraction During Anterior Ankle Arthroscopy: A Cadaveric Study
Distance Between the Anterior Distal Tibial Edge and the Anterior Tibial Artery in Distraction and Nondistraction During Anterior Ankle Arthroscopy: A Cadaveric Study
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DOI：
10.1177/1071100717732550
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发表时间：
2018-01-01
影响因子：
2.7
通讯作者：
Sairyo, Koichi
中科院分区：
文献类型：
--
作者：
Tonogai, Ichiro;Hayashi, Fumio;Sairyo, Koichi
背景：前踝关节镜广泛应用于各种骨关节病。然而，踝关节的牵张可能会使胫前动脉(ATA)在手术过程中面临受伤的风险。本研究的目的是通过关节腔内注射生理盐水来评价踝关节牵张和非牵张时胫骨远端前缘到ATA的距离的差异。采用自行研制的可重复定位的牵引器，在踝关节牵张和非牵张状态下，测量胫骨远端前缘至ATA的距离。结果：在未注射生理盐水的情况下，ATA与胫骨远端前缘最近、中、远端的距离分别为0.5 mm、3.9 mm、7.4 mm和3.7 mm、7.2 mm、11.6 mm。分别用生理盐水注射，在非分心状态下。分别为2.2 mm、5.9 mm和9.8 mm，分别为1.7 mm、5.1 mm和8.8 mm，均为生理盐水注射。结论：在前关节镜手术中，关节腔内注射生理盐水扩大关节间隙时，胫骨远端前缘距ATA的距离增大，而踝关节的牵张距离减小。临床意义：踝关节镜检查时，不注射生理盐水或牵张时，ATA与周围结构的解剖关系可能更危险。
Background: Anterior ankle arthroscopy is widely applied for various osteoarthropathies. However, distraction of the ankle may put the anterior tibial artery (ATA) at risk of injury during the procedure. The purpose of this study was to assess the difference in the distance between the anterior distal tibial edge and the ATA in distraction and nondistraction of the ankle with joint space expansion by saline injection into the joint.Methods: Eight whole fresh-frozen cadaveric feet (mean age 78.9 years) were used. Barium sulfate suspension was injected into the popliteal artery of each specimen, and the distance from 3 aspects of the anterior distal tibial edge to the ATA was measured to evaluate the possibility of damage to the ATA based on computed tomography (CT) scans, in ankle distraction and nondistraction, using a traction device developed for reproducible ankle positioning inside the CT scanner.Results: The distance between the ATA and the most proximal, middle, and distal parts of the anterior distal tibial edge was 0.5 mm, 3.9 mm, and 7.4 mm, respectively, without saline injection, and 3.7 mm, 7.2 mm, and 11.6 mm, respectively, with saline injection, in nondistraction. The distance was 2.2 mm, 5.9 mm, and 9.8 mm, respectively, with 5-kg distraction, and 1.7 mm, 5.1 mm, and 8.8 mm, respectively, with 10-kg distraction, both with saline injection, respectively.Conclusion: The distance between the anterior distal tibial edge and the ATA with joint space expansion by saline injection into the joint increased, and that distance in distraction of the ankle decreased during anterior arthroscopic surgery.Clinical Relevance: The anatomic relationship of the ATA to its surrounding structures may be at more risk without saline injection or with distraction during anterior ankle arthroscopy.