目的 对膝关节后侧结构进行解剖学研究，探寻胫骨平台后外侧骨折手术更适宜入路。 方法 成人大体标本5具（膝关节10侧），按层次解剖，观察胫骨平台后侧肌的分布和形态特点以及血管、神经走形，测量腘动脉、胫后动脉、胫前动脉、腓动脉、胫骨滋养动脉直径以及位置关系数据，腘肌、比目鱼肌和腓肠肌相关数据。 结果 胫骨平台后侧具有“裸露三角、垫状保护和袋状空间”三大解剖特点。腘动脉、胫后动脉走形于胫骨上端外1/3及胫骨外缘，该特点决定了从内侧进入，向外侧牵拉，能更好地显露胫骨平台后外侧；腘肌形态及相关数据与文献记载不同，冠状面测量腘动脉、胫后动脉与胫骨内、外缘的距离分别为（2.98±0.26） cm、（1.73±1.14） cm，两侧比较有统计学差异（t=9.547，P=0.000）；胫前动脉、腓动脉和胫骨滋养动脉发出部位到胫骨平台平面的距离分别为（5.33±0.44） cm、（10.40±0.28） cm和（10.59±0.23） cm，其血管外径分别为（4.91±0.17） mm，（2.28±0.24） mm和（1.44±0.08） mm。腘肌内侧边与上边的夹角约120°，上边长（4.11±0.07） cm，内侧边长（8.68±0.13） cm；也获得了腓肠肌、比目鱼肌相关数据。裸露三角的面积为（4.36±0.15） cm2。 结论 从后内侧到达胫骨平台后外侧存在一个“潜行”通道，肌垫状结构可保护膝后侧重要血管神经，利于充分显露、复位与固定后外侧胫骨平台骨折，具有安全、简单、微创等优点。
Abstract
Objective To conduct an in-depth anatomic study on the posterior relevant structures of the knee joint, so as to provide more appropriate approach for the surgical treatment of posterolateral tibial plateau fractures. Methods A total of 10 knee joints of 5 adult cadaveric specimens that were fixed by formaldehyde were observed to learn its anatomic structure through the hierarchical dissection of the posterior knee. The distribution and morphological characteristics of the posterior knee muscles, as well as the course of the associated vessels and nerves, were observed. The diameters and positional relationships of the popliteal artery, posterior tibial artery, anterior tibial artery, peroneal artery, and tibial nutrient artery were measured. Additionally, relevant data of the popliteus, soleus, and gastrocnemius muscles were recorded. Results There were three anatomical structures and features: bare triangle, cushion-like protection, and pouch-like space behind the tibial plateau. The popliteal artery and the posterior tibial artery were located in the lateral one-third of the proximal tibia and along the lateral border of the tibia. These anatomical features determined that medial approach with lateral traction could provide optimal exposure of the posterolateral tibial plateau. The morphological characteristics and related data of the popliteus muscle exhibited discrepancies from the current anatomical literature. The distances from the popliteal artery and posterior tibial artery to the medial and lateral borders of the tibia measured in the coronal plane were (2.98±0.26) cm and (1.73±1.14) cm, respectively, showing significant differences (P<0.05, t=9.547, P=0.000). The heights from the origins of the anterior tibial artery, peroneal artery and tibial nutrient artery to the tibial plateau were (5.33±0.44) cm, (10.40±0.28) cm, and (10.59±0.23) cm, respectively, their outer diameters were (4.91±0.17) mm, (2.28±0.24) mm, and (1.44±0.08) mm, respectively. The angle between the medial vertical border and the superior border of the popliteal muscle was approximately 120°, with the length of the superior border (4.11±0.07) cm and the length of the medial vertical border (8.68±0.13) cm. Additionally, relevant data for the gastrocnemius and soleus muscles was obtained. The area of the bare triangle was (4.36±0.15) cm². Conclusions There is a "subtle" pathway from the posteromedial to the posterolateral tibial plateau, through which a muscular cushion-like structure protects the critical neurovascular structures at posterior aspect of the knee joint. This approach allows for full exposure, reduction, and fixation of posterolateral tibial plateau fractures, offering advantages such as safety, simplicity, and minimally invasive technique.
关键词
手术入路； /
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胫骨平台骨折； /
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后内侧； /
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后外侧； /
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应用解剖
Key words
Surgical approach; /
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Tibial plateau fractures; /
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Posteromedial; /
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Posterolateral; /
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Applied anatomy
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参考文献
[1] Kfuri M, Schatzker J. Revisiting the Schatzker classification of tibial plateau fracters[J]. Injury, 2018, 49(10): 2252-2263. DOI:10.1016/j.injury.2018.11.010.
[2] J Van den Berg, B Struelens, S Nijis, et al. Value of three-dimensional computed tomography reconstruction in the treatment of posterior tibial plateau fractures[J]. Knee, 2020, 27(1): 3-8. DOI:10.1016/j.knee.2019. 11.001.
[3] Chen L, Xiong Y, Yan C, et al. Fibular neck osteotomy approach in treatment of posterolateral tibial plateau fractures: a retrospective case series[J]. Med Sci Monit, 2020, 26: e9273701-e9273707. DOI: 10.12659/MSM.927370.
[4] Flury A, Hodel S, Andronic O, et al. Extent of posterolateral tibial plateau impaction fracture correlates with anterolateral complex injury and has an impact on functional outcome after ACL reconstruction[J]. Knee Surg Sports Traumatol Arthrosc, 2023, 31(6): 2266-2273. DOI: 10.1007/s00167-022-07282-y.
[5] Lu Y, Wang G, Ren C, et al. Partial fibular head osteotomy is an alternative option in treatment of posterolateral tibial plateau fractures: a retrospective analysis[J]. Front Surg, 2022, 9: 915814. DOI:10.3389/fsurg.2022.915814.
[6] Giordano V, Esteves RP, Silva FP, et al. Posterolateral fractures of the tibial plateau revisited: a simplified treatment algorithm[J]. J Knee Surg, 2022, 35(9): 959-970. DOI:10.1055/s-0040-1721026.
[7] Liu CD, Hu SJ, Chang SM, et al. Treatment of posterolateral tibial plateau fractures: a narrative review and therapeutic strategy[J]. Int J Surg, 2025, 111(1): 1071-1082. DOI:10.1097/JS9.0000000000001955.
[8] Juan BM, Beatriz OL, Pau FC, et al. Modified Oblique Lobenhoffer (MOL) approach for posterolateral and posteromedial column access in tibial plateau fractures: a detailed cadaveric anatomical study[J]. J Orthop Traumatol, 2024, 25(1): 27. DOI:10.1186/s10195-024-00769-z.
[9] Latip MF, Syafid S, Mohamad Khslil AF, et al. Tibial plateau fracture: implementing the modified frosh approach for dual-benefit achievement[J]. Cureus, 2025, 17(1): e77863. DOI:10.7759/cureus.77863.
[10]Yang SZ, Lian Y, Yang L, et al. Fibular head osteotomy: a new technique for better exposure of postero- lateral tibial plateau fracture[J]. J Orthop Traumatol, 2025, 26(1): 19. DOI:10.1186/s10195-025-00836-z.
[11]Hu JX, Zhang HX. Treatment of posterolateral tibial plateau fractures through the articular line approach[J]. BMC Musculoskelet Disord, 2025, 26(1): 47. DOI:10.1186/s12891-025-08321-8.
[12] Cardon JJ, Dekeyser GJ, Peterson AC, et al. Medial head of the gastrocnemius tenotomy through a posteromedial approach significantly improves surgical accessibility of the Tibial plateau[J]. J Orthop Trauma, 2023, 37(1): 44-49. DOI:10.1097/BOT.000000000 0002462.
[13] Richard L Drake, A Wayne Vogl, Adam W M Mitchell. 格氏解剖学基础教程[M]. 北京: 北京大学医学出版社, 2013: 305-314.
Richard L Drake, A Wayne Vogl, Adam W M Mitchell. Gray′s Basic Anatomy[M]. Beijing: Peking University Medical Press, 2013: 305-314.
[14]Orapiriyakul W, Apivatthakakul T, Phornphutkul C. Posterolateral tibial plateau fractures,how to buttress? Reversed L posteromedial or the posterolateral approach:a comparative cadaveric study[J]. Arch Orthop Trauma Surg, 2018, 138(4): 505-513. DOI:10.1007/s00402-018-2875-3.
[15]Hu SJ, Li SJ, Chang SM，et al. Surgical exposure to posterolateral quadrant tibial plateau fractures:an anatomic comparison of posterolateral and posteromedial approaches[J]. J Orthop Surg Res, 2022, 17(1): 346. DOI: 10.1186/s13018-022-03236-9.
[16]Millar SC, Fraysse F, Arnold JB, et al. 3D modelling of tibial plateau fractures: variability in fracture location and characteristics across Schatzker fracture types[J]. Injury, 2021, 52(8): 2415-2424. DOI: 10.1016/j.injury.2021.01.019.
[17]Mancini N, Salvato D, Delmastro E, et al. A modified Frosch approach for posterior tibial plateau fractures: Technical note and case series[J]. Injury，2023, 54 Suppl 1: S9-S14. DOI: 10.1016/j.injury.2021.03.030.
[18]Zhou XJ, Zhou JS, Qian HJ, et al. A newly designed anatomical plate for the therapy of posterolateral tibial plateau fracture via supra-fibular-head approach: a retrospective study[J]. Sci Rep, 2024, 14(1): 11722. DOI: 10.1038/s41598-024-62227-4.
[19]Jian Z, Jiang X, Li D, et al. Finite element analysis of novel anatomical plate in posterolateral plateau fractures[J]. Front Surg, 2024, 11: 1346462. DOI: 10.3389/fsurg.2024.1346462.
基金
河北省政府资助临床医学优秀人才项目（ZF2023247）
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