■软组织在稳定膝关节周围截骨术的铰接点中起着重要作用。然而,关于外侧闭合楔形股骨远端截骨术(LCWDFO)的铰链位置周围软组织的解剖特征的数据不足.
■要(1)对LCWDFO的铰链位置周围的软组织进行解剖学分析,(2)根据解剖分析结果对软组织进行组织学分析,和(3)放射学定义适当的铰链点,以防止不稳定的铰链骨折基于解剖和组织学分析的结果。
■描述性实验室研究。
■在20具尸体的膝盖(年龄,82.7±7.8年;范围,60-96岁),对股骨远端内侧的软组织进行了解剖学分析。对骨膜的厚度和内收腱(AT)的直接插入进行了组织学检查,并使用电子显微镜进行了测量。骨膜的厚度以图形方式显示,使用图像编辑软件覆盖骨膜和膝关节X线照片。基于AT的骨膜厚度和附着确定合适的铰链位置。
■干phy端骨膜的平均厚度为352.7±58.6µm(范围,213.6-503.4µm)。叠加的照片和X射线照片显示,骨膜的厚度在对应于股骨骨干端和干meta端之间过渡的部分发生了变化。从内收肌结节向远端方向连接到股骨远端内侧的AT的平均宽度为7.9±1.3mm(范围,6.3-9.7毫米)。
■结果表明,骨膜和AT在由内收肌结节的顶点和股骨外侧髁后部的上边界包围的区域内支撑LCWDFO的铰链。
■当铰接点位于内收肌结节的顶点和股骨外侧髁后部的上边界所包围的区域内时,这些软组织作为稳定剂,并且没有切入关节空间的风险。
UNASSIGNED: Soft tissue plays an important role in stabilizing the hinge point for osteotomy around the knee. However, insufficient data are available on the anatomic features of the soft tissue around the hinge position for lateral closing-wedge distal femoral osteotomy (LCWDFO).
UNASSIGNED: To (1) anatomically analyze the soft tissue around the hinge position for LCWDFO, (2) histologically analyze the soft tissue based on the anatomic analysis results, and (3) radiologically define the appropriate hinge point to prevent unstable hinge fracture based on the results of the anatomic and histological analyses.
UNASSIGNED: Descriptive laboratory
study.
UNASSIGNED: In 20 cadaveric knees (age, 82.7 ± 7.8 years; range, 60-96 years), the soft tissue of the distal medial side of the femur was anatomically analyzed. The thicknesses of the
periosteum and direct insertion of the adductor tendon (AT) were histologically examined and measured using an electron microscope. The thickness of the
periosteum was visualized graphically, and the graph of the
periosteum and radiograph of the knee were overlaid using image editing software. The appropriate hinge position was determined based on the periosteal thickness and attachment of the AT.
UNASSIGNED: The mean thickness of the
periosteum of the metaphysis was 352.7 ± 58.6 µm (range, 213.6-503.4 µm). The overlaid graph and radiograph revealed that the thickness of the periosteum changed at the part corresponding to the transition between the diaphyseal and metaphyseal ends of the femur. The mean width of the AT attached to the distal medial femur from the adductor tubercle toward the distal direction was 7.9 ± 1.3 mm (range, 6.3-9.7 mm).
UNASSIGNED: Results indicated that the
periosteum and AT support the hinge for LCWDFO within the area surrounded by the apex of the adductor tubercle and the upper border of the posterior part of the lateral femoral condyle.
UNASSIGNED: When the hinge point is located within the area surrounded by the apex of the adductor tubercle and the upper border of the posterior part of the lateral femoral condyle, these soft tissues work as stabilizers, and there is no risk of cutting into the joint space.