背景:棉花截骨术,或内侧楔形骨(MC)的背侧开口楔形截骨术,用于解决中间柱对齐以恢复支撑的静态三角形。关于切口和截骨术有许多描述的技术。成功完成截骨需要了解解剖学,特别是内侧背侧皮神经(MDCN)的位置。本研究描述了MDCN,胫骨前肌,伸-幻觉-长腱,和韧带附着在MC上。还描述了确定截骨术的安全位置的技术。
方法:本研究使用12个新鲜冷冻的成年足部标本(7名男性和5名女性)。解剖了MDCN及其分支,并记录了其与MC的关系。测量截骨倾斜角和与MC周围结构的关系。
结果:MDCN在MC的背侧内侧和远端移动,并观察到MC的一个小分支。倾斜角为80.1±1.4度。从远端关节面到楔形文字中线和到骨间韧带的距离没有显着差异(P=0.69),或从远端关节面到第二睑板关节和Lisfranc韧带起源之间的距离(P=.12)。
结论:背侧-内侧-斜切口能有效保护MDCN和MC。我们认为截骨术应在安全区进行,以保持开口楔形的稳定性。
结论:背内侧斜切口可降低MDCN和胫前肌腱损伤的风险。
BACKGROUND: The Cotton osteotomy, or dorsal-opening wedge osteotomy of the medial cuneiform (MC), is used to address medial column alignment to restore the static-triangle of support. There are many described techniques regarding the incision and osteotomy. Successful completion of the osteotomy requires knowledge of the anatomy, particularly the location of the medial dorsal cutaneous nerve (MDCN). This study describes the relationship between MDCN, tibialis anterior, extensor-hallucis-longus tendon, and ligamentous attachments to the MC. A technique to determine a safe location for the osteotomy is also described.
METHODS: Twelve fresh-frozen adult foot specimens were used for this study (7 male and 5 female). The MDCN and its branches were dissected and its relationship with the MC was documented. Osteotomy tilt angle and relationship to structures around the MC were measured.
RESULTS: MDCN traveled medially and distally over the dorsum of the MC, and a small branch to the MC was observed. The tilt angle was 80.1 ±1.4 degrees. There was no significant difference between the distance from the distal-articular surface to the midline of the cuneiform and to the interosseous ligament (P = .69), or between the distance from the distal-articular surface to the second tarsometatarsal joint and to the origin of the Lisfranc ligament (P = .12).
CONCLUSIONS: The dorsal-medial-oblique incision effectively protected MDCN and the MC. We believe the osteotomy should be performed in the safe zone to maintain the stability of the opening wedge.
CONCLUSIONS: The dorsal-medial-oblique incision could reduce the risk of injury to the MDCN and the tibialis-anterior tendon.