踝关节周围皮神经应用解剖学研究及意义

Anatomy study on cutaneous nerves surrounding the ankle joint and its significance

目的研究隐神经、腓浅神经、腓肠神经在踝关节周围的走行位置、毗邻关系,为临床踝关节周围皮神经阻滞麻醉提供解剖学依据。方法采用局部解剖学实验教学用尸体标本15例,观察隐神经、腓浅神经、腓肠神经在踝关节周围的位置及毗邻关系,测量神经压扁径,在内外踝尖连线上测量神经至内外踝尖或跟腱边缘的距离。结果隐神经在内外踝最高点的连线上,位于大隐静脉外侧,压扁径(0.342±0.14)cm,距内踝尖(1.857±0.17)cm,距外踝尖(6.838±0.32)cm;腓浅神经在内外踝最高点的连线上,压扁径(0.264±0.13)cm,距内踝尖(5.334±0.33)cm,距外踝尖(4.424±0.46)cm;腓肠神经在踝关节周围,位于外踝沟处、小隐静脉外侧,压扁径(0.250±0.12)cm,距跟腱边缘(2.745±0.21)cm,距外踝尖(2.660±0.16)cm。结论依据隐神经、腓浅神经、腓肠神经在踝关节周围至内外踝尖或跟腱边缘的距离、压扁径、毗邻结构关系,可提高皮神经阻滞麻醉的精准度,减少对其他组织的损伤,具有一定的临床参考意义。

Objective To study the position and adjacent relationship of saphenous nerve,superficial peroneal nerve and sural nerve around the ankle joint,so as to provide anatomical basis for clinical cutaneous nerve block anesthesia around the ankle joint.Methods Totally 15 cadaver specimens for the experimental teaching of regional anatomy were used to observe the position and adjacent relationship of saphenous nerve,superficial peroneal nerve and sural nerve around the ankle joint.The flattening diameter of the nerve was measured and the distance from the nerve to the medial and lateral malleolus cusps or to the edge of the Achilles tendon on the connecting line of the medial and lateral malleolus cusps were measured.Results The saphenous nerve was located lateral to the great saphenous vein on the connecting line of the highest point of the medial and lateral malleolus,with the flattening diameter of(0.342±0.14)cm,and the distance to the medial malleolus cusp was(1.857±0.17)cm,and the distance to the lateral malleolus cusp was(6.838±0.32)cm;the superficial peroneal nerve was located on the connecting line of the highest point of the medial and lateral malleolus,with the flattening diameter of(0.264±0.13)cm,and the distance to the medial malleolus cusp was(5.334±0.33)cm,and the distance to the lateral malleolus cusp was(4.244±0.46)cm;the sural nerve was around the ankle joint,located in the lateral malleolar sulcus lateral to the small saphenous vein,with the flattening diameter of(0.250±0.12)cm,and the distance to the Achilles tendon was(2.745±0.21)cm,and the distance to the lateral malleolus cusp was(2.660±0.16)cm.Conclusion The accuracy of cutaneous nerve block will be improved and the injury to other tissues will be reduced according to the distance to the medial and lateral malleolus cusps or to the edge of the Achilles tendon,the flattening diameter and the adjacent structure of saphenous nerve,superficial peroneal nerve and sural nerve around the malleolus joint,which has certain clinical reference significances.