Trauma Emergency Center, the Third Hospital of Hebei Medical University, Orthopaedic Research Institute of Hebei Province, Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang 050051, China
Abstract：Objective To investigate the safety and feasibility of the anterior medial approach of distal thigh in the treatment of distal femoral fractures.Methods (1) A retrospective study was conducted on the MRI data of 20 subjects with 40 sides who underwent bilateral middle and lower thigh MRI examination in the MRI room of the Third Hospital of Hebei Medical University from August 2016 to February 2017. Among the 20 cases, 12 were male and 8 were female, aged from 22 to 59 years, and no significant abnormality was found on MRI. Scanning range: from the horizontal line of the medial femoral condyle (at 0 cm) to 18.5 cm above it. Scanning layer thickness 5 mm, 15 mm spacing, a total of 10 slices (Ⅰ-Ⅹ level). The picture archiving and communication systems (PACS) were used to measure the shortest distance between the anterior medial surgical approach (the expected surgical route) and the femoral artery at each scanning level. (2) The internal fixation process of the anterior medial approach for distal femoral fractures was simulated in one fresh adult male cadaver specimen, and applied anatomical observation was made on the anatomical layers and structures involved in the approach.Results (1) MRI measurements of 20 subjects with 40 sides: there was no significant difference between the measured values of the shortest distance between the anterior medial approach and the femoral artery on the left and right sides, so the data were combined. The distribution of the measurement results at the Ⅰ-Ⅹ levels generally showed a trend of small middle and large two ends and large upper and small lower ends, the largest position was located at 0 cm (level Ⅰ) of the medial condyle of the femur and was 46.72-49.47 (48.02±0.84) mm, the smallest position was within the range of 10-10.50 cm above the horizontal line of the medial condyle of the femur (level Ⅵ) was 23.34-25.05 (24.35±0.52) mm; there was sufficient safe space between the surgical approach and the femoral artery. (2) Simulated operation in the cadaver specimens: the simulated implantation of internal fixation through the anterior medial approach to distal femoral fracture was smooth, and the operation did not disturb femoral vessels, femoral nerves and their branches. Anatomical observations confirmed that the surgical approach can be entered along the muscle space, and the surrounding anatomical levels and structures were clearly displayed.Conclusions The anterior medial approach of distal thigh in the treatment of distal femoral fractures is safe and feasible, and it is a good complement to the traditional lateral approach for the treatment of distal femoral fractures.
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2020, Vol. 25 
