关键词: 胫骨平台, 骨折, 后内侧入路, 后外侧入路, 应用解剖

Abstract:

Objective　To compare deep anatomical structures of posterolateral and posteromedial approaches, andanalyze the limitations and risk of injury to important structures during surgical dissection.Method　Five lower limb specimens were dissected to measure the perforating level of the anterior tibial artery at the interosseous membrane fissure and the shielding percentage by fibular head to the posterolateral cortex. Clinically, 20 cases were treated via a posterolateralor posteromedial approach. The two approaches were compared with each other.　 Result　The posterolateral approach had three major disadvantages:(1) the width of the anterior vascular bundle was about 1 cm; the distance between the level ofthe anterior tibial artery perforating point and tibial plateau/superior tip of fibular head was 4.93 cm and 3.77 cm, respectively. The distance for the superior concomitant vein was 4.41 cm and 3.25 cm in average, respectively, which limit the incision exposure. (2) The percentage of the posterolateral cortical area shielded by fibular head was 61.7% in average. (3) In order to expose the posterolateral articular surface, partial structure of posterolateral corner was destroyed, including the popliteus tendon complex, ligament and joint capsule, etc.　Conclusion　A posteromedial approach via the medial head of gastrocnemius-soleus maybe more suitable to expose isolated posterolateral quadrant tibial plateau fracture.

Key words: Tibial plateau, Fracture, Posteromedial approach, Posterolateral approach, Applied anatomy