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Surgical Anatomy of the Medial Cuneiform (Cotton) Osteotomy

机译：内侧楔形状（棉）骨质术的外科解剖学

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Background: The Cotton osteotomy, or dorsal-opening wedge osteotomy of the medial cuneiform (MC), is used to address medial column alignment to restore the static-triangle of support. There are many described techniques regarding the incision and osteotomy. Successful completion of the osteotomy requires knowledge of the anatomy, particularly the location of the medial dorsal cutaneous nerve (MDCN). This study describes the relationship between MDCN, tibialis anterior, extensor-hallucis-longus tendon, and ligamentous attachments to the MC. A technique to determine a safe location for the osteotomy is also described. Methods: Twelve fresh-frozen adult foot specimens were used for this study (7 male and 5 female). The MDCN and its branches were dissected and its relationship with the MC was documented. Osteotomy tilt angle and relationship to structures around the MC were measured. Results: MDCN traveled medially and distally over the dorsum of the MC, and a small branch to the MC was observed. The tilt angle was 80.1 ±1.4 degrees. There was no significant difference between the distance from the distal-articular surface to the midline of the cuneiform and to the interosseous ligament (P = .69), or between the distance from the distal-articular surface to the second tarsometatarsal joint and to the origin of the Lisfranc ligament (P = .12). Conclusions: The dorsal-medial-oblique incision effectively protected MDCN and the MC. We believe the osteotomy should be performed in the safe zone to maintain the stability of the opening wedge. Clinical relevance: The dorsal-medial-oblique incision could reduce the risk of injury to the MDCN and the tibialis-anterior tendon.
机译：背景技术棉骨质切开术或内侧楔形物（MC）的背部开口楔形骨切断，用于解决内侧柱对齐以恢复静态三角形的静态三角形。有许多关于切口和截骨术的技术。成功完成截骨术需要了解解剖学，特别是内侧皮神经（MDCN）的位置。本研究描述了MDCN，Tibialis前，延伸率 - 千兆腱和MC的贴眼附件之间的关系。还描述了确定截骨术的安全位置的技术。方法：使用12种新鲜冷冻成人脚标本，用于本研究（7只雄性和5雌性）。解剖MDCN及其分支并记录了与MC的关系。测量截骨倾斜角度和与MC周围结构的关系。结果：MDCN在MC的背侧内侧和远侧行进，观察到MC的小分支。倾斜角度为80.1±1.4度。与楔形状的远端表面与楔形状的中线的距离与斜形韧带（p = .69）之间的距离之间没有显着差异，或者在远端关节表面到第二塔畸形的距离之间的距离和距离Lisfranc韧带的起源（p = .12）。结论：背侧内侧切口有效保护MDCN和MC。我们认为截骨术应在安全区内进行，以保持开口楔的稳定性。临床相关性：背侧内侧倾斜切口可以降低MDCN和胫骨前肌腱损伤的风险。

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