安全锯切条件防止各种股骨远端截骨术中腘动脉损伤:三维模拟分析

Se-Han Jung, Min Jung, Kwangho Chung, Hyun-Soo Moon, Junwoo Byun, So-Heun Lee, Sung-Hwan Kim
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Specifically, after formation of the osteotomy plane that passes the designated hinge point and primary cutting start point, the plane was rotated by 5° and 10° to create the 0°, 5°, and 10° osteotomy planes. Minimal distances to the popliteal artery from the posterior cortex and posterior cortical line (dPA-PC, dPA-PCL) were measured in each osteotomy plane. A distance &lt;10 mm was defined as “at risk.” Frontal safe sawing index (FSSI), maximal safe sawing angles (MSSAs), and maximal safe osteotomy angles (MSOAs) were analyzed to evaluate the safety margin. Results: The FSSI was significantly higher in MCW-DFO than LCW-DFO across all osteotomy planes ( <jats:italic>P</jats:italic> &lt; .001). In MCW-DFO, FSSI decreased with higher-degree upper cuts ( <jats:italic>P</jats:italic> &lt; .001), while in LCW-DFO, it was maintained. The mean minimal distance to the popliteal artery from the posterior cortex ranged from 13 to 14 mm in all DFO simulations. 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引用次数: 0

摘要

背景:股骨远端截骨术(DFO)的应用越来越普遍,DFO期间腘动脉损伤可能是毁灭性的。目的:通过分析截骨平面内腘动脉的走行及与关键结构的距离,确定DFO的安全锯切角度,防止腘动脉损伤。研究设计:描述性实验室研究。方法:对27例患者的健康腘动脉和股骨进行三维重建,模拟内侧和外侧闭合楔形DFO (MCW-DFO和LCW-DFO)。具体而言,通过指定铰点和主要切割起点的截骨平面形成后,将该平面旋转5°和10°,形成0°、5°和10°的截骨平面。在每个截骨平面测量从后皮质和后皮质线到腘动脉的最小距离(dPA-PC, dPA-PCL)。距离10毫米被定义为“有危险”。分析正面安全锯切指数(FSSI)、最大安全锯切角(MSSAs)和最大安全截骨角(MSOAs)来评价安全裕度。结果:在所有截骨平面上,MCW-DFO的FSSI明显高于LCW-DFO (P <;措施)。在MCW-DFO中,FSSI随着更高程度的上切而下降(P <;.001),而LCW-DFO则维持不变。在所有DFO模拟中,从后皮质到腘动脉的平均最小距离为13至14 mm。MCW-DFO和LCW-DFO的dPA-PC下降程度较高(P <;.001), dPA-PCL持续短于dPA-PC (P <;措施)。在所有情况下,dPA-PCL的危险比均高于dPA-PC,倾向于沿皮质正常曲率切割而不是直线切割。MCW-DFO的MSSA在5°左右,截骨平面间无明显差异。考虑到MSSAs的95%置信区间,LCW-DFO与MCW-DFO相比具有更小的安全裕度。然而,LCW-DFO的MSOA值高于MCW-DFO (P <;措施)。dPA-PC与身高、体重、体质指数、经髁距离(P <;. 05)。结论/临床意义:在不同的DFO情况下,截骨术的安全范围可能有所不同。当进行DFO时,必须了解与腘动脉的走行和股后皮质的正常弯曲有关的安全提示。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Safe Sawing Conditions to Prevent Popliteal Artery Injury in Various Distal Femoral Osteotomies: Three-dimensional Simulation Analysis
Background: Distal femoral osteotomy (DFO) use is increasing in popularity, and popliteal artery injury during DFO can be devastating. Purpose: To determine the safe sawing angles in DFO to prevent popliteal artery injury by analyzing the artery's course and the distances from key structures within the osteotomy plane. Study Design: Descriptive laboratory study. Methods: Three-dimensional images of the healthy popliteal artery and femur were reconstructed from computed tomography angiography scans of 27 patients, and medial and lateral closing-wedge DFO (MCW-DFO and LCW-DFO) was simulated. Specifically, after formation of the osteotomy plane that passes the designated hinge point and primary cutting start point, the plane was rotated by 5° and 10° to create the 0°, 5°, and 10° osteotomy planes. Minimal distances to the popliteal artery from the posterior cortex and posterior cortical line (dPA-PC, dPA-PCL) were measured in each osteotomy plane. A distance <10 mm was defined as “at risk.” Frontal safe sawing index (FSSI), maximal safe sawing angles (MSSAs), and maximal safe osteotomy angles (MSOAs) were analyzed to evaluate the safety margin. Results: The FSSI was significantly higher in MCW-DFO than LCW-DFO across all osteotomy planes ( P < .001). In MCW-DFO, FSSI decreased with higher-degree upper cuts ( P < .001), while in LCW-DFO, it was maintained. The mean minimal distance to the popliteal artery from the posterior cortex ranged from 13 to 14 mm in all DFO simulations. MCW-DFO and LCW-DFO showed a decrease in dPA-PC with higher-degree cuts ( P < .001), and dPA-PCL was consistently shorter than dPA-PC ( P < .001). The at-risk ratio of dPA-PCL was higher than that of dPA-PC in all conditions, favoring cutting along the normal curvature of the cortex over cutting straight. The MSSA for MCW-DFO was around 5°, with no significant variation between osteotomy planes. LCW-DFO had a smaller safety margin when compared with MCW-DFO, considering the 95% confidence interval of MSSAs. However, MSOA values were higher in LCW-DFO than MCW-DFO ( P < .001). The dPA-PC was correlated with height, weight, body mass index, and transepicondylar distance ( P < .05). Conclusion/Clinical Relevance: The safety margin during osteotomies in various DFO scenarios may vary. When DFO is performed, it is essential to be aware of safety tips related to the course of the popliteal artery and the normal curvature of the femoral posterior cortex.
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