跟骨内移截骨术中跟骨内侧的截骨安全区

摘要

目的 探讨跟骨内移截骨术中跟骨内侧的截骨安全区.方法 10具防腐成人尸体的20只足部标本上,取跟骨结节内缘最低点为A点,内踝尖最低点为B点,足舟骨结节为C点.显露跟骨内侧各神经血管结构后,用游标卡尺测量AB、AC长度,以及各神经血管结构与AB、AC线段交点与A点间的长度.经统计学检验,各组长度符合正态分布,所以可以用后者的长度均值除以AB、AC长度的均值,计算出各神经血管结构在AB、AC上的分布比例.结果 跟骨内侧神经、足底外侧神经、足底内侧神经、胫后动脉在AB线上分别位于A点后的:29%、57%、66%、60%;而在AC线上跟骨内侧神经、足底外侧动脉、足底外侧神经、足底内侧动脉、足底内侧神经分别位于A点后的:20%、45%、50%、60%、66%.结论 AB线上A点后29%～57%,AC线上A点后20%～45%的区域无重要神经血管走行,满足跟骨内移截骨术在跟骨中后部截骨的要求,可作为跟骨内移截骨术的手术安全区.%Objective To explore the surgical safe zone of the medial displacement calcaneal osteotomy(MDCO).Methods 20 adult cadaveric feet were dissected. On the medial surface of each foot,three palpable anatomic landmarks were choosen and labeled as Point A(the lowest point on the inner margin of calcaneal tuberosity),Point B(the lowest point of inferior medial malleolus),and Point C (navicular tuberosity). The medial neurovascular structures were carefully dissected, then marked. The length of line AB and AC and the distance between the points at which neurovascular structures intersect line AB and AC and the point A were measured by vernier caliper. And then calculate the percentage of these distances respectively on the line AB and AC to mark off the relative safe zone at medial calcaneus to reduce the neurovascular injuries in MDCO. Results On the AB line,MCN,LPN,MPN and PTA were located at 29％、57％、66％、60％ away from point A respectively and On the AC line,MCN,LPA,LPN,MPA and MPN are located at 20％、 45％、 S0％、 60％、 66％ from point A. Conclusion There are no important neurovascular structures on the 29％ to 57％ of the line segment AB and on the 20％to 45％ of the line segment AC,away from the point A. This part of the line segment satisfies the requirement of position in MDCO. Therefore it can be regarded as the safe area of MDCO.