The Anatomical Study Of Meniscal Arteria And Its Applied Significance In Total Knee Arthroplasty

Objective:To explore the origin and distribution of meniscal arteria and study its influence on blood loss in total knee arthroplasty. The great blood loss is one of complications in total knee arthroplasty.How to reduce blood loss and transfusion in total knee arthroplasty is becoming a popular subject.We make autopsy in 5 cadavier specimens to learn the origin and distribution of the meniscal arteria and its branches and roll them in total knee arthroplasty .We make a contrast study on the volume of blood loss and transfusion to evaluate the clinical significance on reducing postoperative blood loss by rolling the the meniscal arteria in total knee arthroplasty.Methods: We dissected 5 cadavier specimens, observed the origin and distribution of the meniscal arteria ,and roll the meniscal arteria in total knee arthroplasty depended on the anatomical basis provide by autopsy.25 patients who suffered total knee arthroplasty in 1rst hospital of changzhou from June.2005 to Jan.2007 were caculated into experiment group according to experiment protocol and 13 patient who suffered the same surgeons in same the hospital from Jan.2004 to 2005 were caculated into contrast group according to the same experiment protocol, ,all the operations were executed by the same surgeon team,all the patients were received the same postoperative treatment according to the experiement protocol. we make a contrast analysis on the effected factors such as age,sex,weight,height,blood pressure, anaesthesia type, tourniquet and surgical time,thrombine function,HCT level,Hb level and compare the postoperative blood loss and transfusion in two groups.Results: We find out the meniscal arteria come from medial superior genicular artery,medial inferior genicular artery,lateral inferior genicular artery,middle genicular artery,descending genicular artery, posterior medial and lateral genicular arteries.We divided the meniscus into posterior area and anterior area according to the boundary between the medial collateral ligament and the middleline of the popliteal tendon, the arteries in the posterior area of meniscus come from the posterior medial and lateral genicular arteries,the anterior part of the medial meniscus is supllied by medial superior genicular artery, medialinferior genicular artery,descending genicular artery and the branches of lateral inferior genicular artery,the anterior part of the lateral meniscus is supplied by lateral inferior genicular artery and the branches of middle genicular artery.All the stem and branches arteries form a vascular loop aroud the knee.We make a contrast analysis ahout the effected factors on postoperative blood loss in total knee arthroplasty between the experiement group(n=25) and the contrast group(n=13),we can find out there are no difference(p<0.05) on age, weight,blood pressure,average hemoglobin(Hb) ,platelet count level,and thrombin function in two groups which collected preioperatively,the perioperative tourniquet time,surgical time, and anaesthesia type are also no difference in two groups.8 patients were received blood transfusion in experiement group and 7 in contrast group,the total volume of postoperative blood transfusion in experiment group was 2920ml (average365±39ml)and the contrast group was 3535±ml(average505±63ml),the average blood loss in experiment group was 620±103ml and895±113ml in contrast group, there we got different results on postoperative blood loss and transfusion by stastical analysis.But the postoperative complications(effection and DVT),the rehabilation of knee function are similar in two groups.Conclusions: The meniscal arteria especially those come from the poster of the menicus play the important role on reducing blood loss in total knee arthroplasty.We explored and defined the origin and distribution of meniscal arteria by autopsy. We conclude that rolling meniscal arteria in total knee arthroplasty can reduce blood loss dramatically by the contrast experiment.