Quantitative-MRI analysis of the effects of retrograde nailing on vascularity of the distal femur: A cadaveric study

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee Pub Date : 2024-08-01 DOI:10.1016/j.knee.2024.07.011

Amarpal Cheema , Aleksey Dvorzhinskiy , Craig E. Klinger , Jacob D. Feingold , Burak Altintas , Jonathan P. Dyke , David L. Helfet , David S. Wellman

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引用次数: 0

Abstract

Background

Distal femur fractures remain treatment challenges with a considerable postoperative non-union rate. Concern remains that surgery may compromise osseous vascularity. This study aimed to determine effects of retrograde femoral intramedullary nailing (RFIN) on distal femur vascularity, and the locations of the middle genicular artery terminal branches in relation to the standard RFIN entry point.

Methods

Five lower limb cadaveric pairs were obtained (ten specimens). Experimental limbs were randomly assigned, and contralateral limbs served as controls. An 11 mm femoral nail was implanted in experimental specimens. Controls only underwent a medial parapatellar incision with capsulotomy. Quantitative pre- and post-contrast-MRI was performed to assess arterial contributions to distal femur regions. Osseous vascularity was further evaluated with contrast-CT imaging. Next, specimens were injected with latex medium, and dissection was performed to assess extraosseous vasculature.

Results

No statistically significant differences were found with quantitative-MRI in experimental and control groups for the entire distal femur or individual regions. The experimental group demonstrated a small mean decrease of 1.4% in distal femur arterial contributions. CT and anatomic dissection confirmed maintenance of middle genicular artery terminal branches. On average, 3.3 (±1.3) terminal branches entered along the posterior intercondylar notch. A mean distance of 15.2 mm (±6.9 mm) was found between the posterior RFIN entry point and these terminal branches.

Conclusions

RFIN did not significantly alter arterial contributions to the distal femur or disrupt the middle genicular artery terminal branches. However, care must be taken to ensure nail entry point accuracy given proximity of the entry point to terminal branches.

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逆行钉对股骨远端血管影响的定量-MRI 分析：尸体研究。

背景：股骨远端骨折仍是治疗难题，术后不愈合率相当高。人们仍然担心手术可能会损害骨血管。本研究旨在确定逆行股骨髓内钉（RFIN）对股骨远端血管的影响，以及与标准 RFIN 进入点相关的膝中动脉末端分支的位置：方法：获得五对下肢尸体（十个标本）。实验肢体随机分配，对侧肢体作为对照。实验肢体植入 11 毫米股骨钉。对照组仅进行了髌旁内侧切口和囊切开术。进行定量前后对比-MRI检查以评估股骨远端区域的动脉贡献。造影剂-CT成像进一步评估了骨血管。然后，给标本注射乳胶培养基，并进行解剖以评估骨外血管：在整个股骨远端或个别区域，实验组和对照组的定量核磁共振成像没有发现明显的统计学差异。实验组股骨远端动脉贡献率平均下降了 1.4%。CT 和解剖解剖证实，股中动脉末端分支得以保留。平均有 3.3（±1.3）个终末分支沿髁间后切迹进入。RFIN 后方进入点与这些终末分支之间的平均距离为 15.2 毫米（±6.9 毫米）：RFIN不会明显改变股骨远端的动脉供血，也不会破坏膝中动脉末端分支。结论：RFIN 不会明显改变股骨远端动脉的供血，也不会破坏膝中动脉的末端分支。然而，由于入钉点靠近末端分支，因此必须注意确保入钉点的准确性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee 医学-外科

CiteScore

3.80

自引率

5.30%

发文量

171

审稿时长

6 months

期刊介绍： The Knee is an international journal publishing studies on the clinical treatment and fundamental biomechanical characteristics of this joint. The aim of the journal is to provide a vehicle relevant to surgeons, biomedical engineers, imaging specialists, materials scientists, rehabilitation personnel and all those with an interest in the knee. The topics covered include, but are not limited to: • Anatomy, physiology, morphology and biochemistry; • Biomechanical studies; • Advances in the development of prosthetic, orthotic and augmentation devices; • Imaging and diagnostic techniques; • Pathology; • Trauma; • Surgery; • Rehabilitation.