Introduction

Arterial injury following total knee arthroplasty (TKA) can be life-threatening. There are some anatomical variations in the popliteal artery (PA) and its branches. In most cases, the PA branches into the anterior tibial artery (ATA) and posterior tibial artery (PTA), which are usually distal to the height of tibial resection in TKA. However, some cases show that the PA branches into the ATA and PTA proximal to the height of tibial resection in TKA. This study aimed to assess the distance from the posterior cortex of the proximal tibia to the anterior wall of the PA or ATA at the height of the tibial cut line, during TKA in the distal and proximal branch groups.

Methods

129 patients (6 patients in the proximal branch group and 123 patients in the distal branch group) were enrolled for this study. For prediction of the distance from the posterior cortex of the proximal tibia to the anterior wall of the PA or ATA, preoperative sagittal and coronal magnetic resonance images and postoperative radiographs were evaluated.

Results

The distance between the posterior cortex of the proximal tibia and the anterior wall of the PA or ATA at the height of the tibial cut line was 1.8 ± 1.1 mm in the proximal branch group and 6.1 ± 2.6 mm in the distal branch group, which was significantly closer in the proximal group (P < .05).

Discussion

The rate of proximal branching was 4.7%. This study clarified that the proximal branching of the ATA from PA significantly decreased the distance between the posterior cortex of the proximal tibia and the anterior wall of the artery.

Conclusions

The proximal branch group has a high risk for arterial injury as the artery may be close to the saw, and appropriate retraction should be performed.

中文翻译：

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胫前动脉从腘动脉的近端分支增加了全膝关节置换术中血管损伤的风险：使用术前磁共振成像和术中发现的回顾性分析

介绍

全膝关节置换术 (TKA) 后的动脉损伤可能会危及生命。腘动脉 (PA) 及其分支存在一些解剖变异。在大多数情况下，PA 分支为胫前动脉 (ATA) 和胫后动脉 (PTA)，它们通常位于 TKA 胫骨切除高度的远端。然而，一些病例显示，在 TKA 中，PA 在胫骨切除高度近端分支为 ATA 和 PTA。本研究旨在评估 TKA 期间远端和近端分支组在胫骨切割线高度处从胫骨近端后皮质到 PA 或 ATA 前壁的距离。

方法

本研究共纳入129例患者（近端组6例，远端组123例）。为了预测从胫骨近端后皮质到 PA 或 ATA 前壁的距离，评估了术前矢状和冠状磁共振图像以及术后 X 光片。

结果

胫骨切线高度处胫骨近端后皮质与 PA 或 ATA 前壁的距离，近端分支组为 1.8±1.1 mm，远端分支组为 6.1±2.6 mm。近端组显着更接近（P < .05）。

讨论

近端分支率为4.7%。该研究阐明，来自 PA 的 ATA 近端分支显着降低了胫骨近端后皮质与动脉前壁之间的距离。

结论

近端分支组动脉损伤的风险很高，因为动脉可能靠近锯，应进行适当的回缩。