外踝术中腓肠神经和腓浅神经损伤后感觉缺失的发生风险(英文)

Risk of anaesthesia after damage of the sural and superficial fibular nerves during the operation on lateral malleolus

背景:外踝骨折术中腓肠神经、腓浅神经或其分支损伤的可能性很多,但危险性到底有多大?目的:探讨外踝术中腓肠神经和腓浅神经损伤的风险,并分析损伤后感觉缺失情况。设计:抽样调查。地点和对象:1999-01/2001-12大理学院解剖教研室对本教研室常规防腐固定的50例成年尸体。干预:对50例(侧)成年尸体的腓肠神经和腓浅神经及其分支作解剖,观测和绘图。主要观察指标:①腓浅神经在小腿前骨筋膜鞘和外侧骨筋膜鞘的位置及其与腓骨长短肌和肌间隔的关系,腓肠神经的行程和分支情况。②腓浅神经或足背中间皮神经浅出点至外踝尖的垂直距离,至腓骨或外踝前缘(若浅出部位低)的水平距离;在外踝尖水平,神经与外踝尖的水平距离。③腓肠神经与外踝后缘最突出处的水平距离,在外踝下方与外踝尖的垂直距离。④腓肠神经和腓浅神经的周围分布。结果:腓浅神经由腓总神经发出后,在小腿上1/3段先在腓骨长肌起始端内下降,继而行于腓骨长肌与腓骨短肌间,以后位于深筋膜的深面,在小腿中,下1/3交界处浅出为皮神经,经踝前至足。腓浅神经或足背中间皮神经浅出点至外踝尖的垂直距离为(90±22)mm,至腓骨或外踝前缘(或浅出部位低)的水平距离为(3±3)mm,其中24%(12/50)浅出点位外踝前缘水平,在外踝尖水平,神经与外踝尖的水平距离为(22±6)mm。?

BACKGROUND: The possibilities of damages to the sural, the superficial fibular nerves or their branches during the operation of fractures of the lateral malleolus are many. However, how great is the risk? OBJECTIVE: To investigate the risk of damage of the sural and superficial fibular nerves during the operation on the lateral malleolus and analyse the state of anaesthesia. DESIGN:A sampling survey. SETTING and PARTICIPANTS:Fifty adult cadavers that were routinely embalmed and fixed by the Anatomical Department of Dali University from January 1999 to December 2001. INTERVENTIONS:The sural and the superficial fibular nerves, and their branches of 50 adult cadavers(sides) were dissected,measured and drawn. MAIN OUTCOME MEASURES:①The position of the superficial fibular nerve in the lateral and anterior compartment of the leg, its relationship with the fibular muscles and the intermuscular septum, and the courses of sural nerves and condition of branches. ②At the level of the superficial fibular nerve or the intermediate dorsal cutaneous nerve of the foot penetrating the deep fascia, the vertical dimension from the locus of the nerve to the tip of the lateral malleolus and the horizontal distance between the nerve and the anterior margin of the fibila or the lateral malleolus(if becoming superficial lower), and at the level of the tip of the lateral malleolus, the horizontal distance from the nerve to the tip of the lateral malleolus. ③The horizontal distance between the sural nerve and the most posterior aspect of the lateral malleolus and the vertical dimension from the nerve to the tip of the lateral malleolus. ④The peripheral distribution of the sural and superficial fibular nerves. RESULTS:The superficial fibular nerve came from the common peroneal nerve. In the proximal one third of the leg, the superficial fibular nerve descended in proximal part of the peroneus longus, and then it descended between the peroneus longus and peroneus brevis, and then passed under the proper fascia afterward. In the relay of the intermediate one third and the distal one third of the leg, the superficial fibular nerve pierced the deep fascia to become the cutaneous nerve, and passed towards the foot by the anterior of the malleolus. The vertical dimension from the locus of the superficial fibular nerve or the intermediate dorsal cutaneous nerve of the foot penetrating the proper fascia to the tip of the lateral malleolus was(90±22) mm.The horizontal distance between the superficial fibular nerve or the intermediate dorsal cutaneous nerve of the foot and the anterior margin of the fibila or the lateral malleolus(if becoming superficial lower) at the level of penetration of the deep fascia was(3±3) mm, and in 24%(12/50) of these cases, the nerve pierced the deep fascia at the anterior margin of the lateral malleolus. At the level of the tip of the lateral malleolus, the horizontal distance from the nerve to the tip of the lateral malleolus was(22±6) mm.The horizontal distance between the sural nerve and the most posterior aspect of the lateral malleolus was(7±4) mm. The vertical dimension from the tip of the lateral malleolus to the sural nerve was(12±7) mm, and in 10%(5/50) of the specimens,the sural nerve was tangent to the tip of the lateral malleolus. These two nervous ramification of malleolus in 78%(39/50) of the specimens could be recognized(28%of them had two resources at the same time). Feet and lateral toes in 38%(19/50) of the specimens were managed by sural nerves. CONCLUSION:Malleolar branches from both the sural and the superficial fibular nerves can be easily damaged during the approach to the lateral malleolus(the possibility is 78%).There is less risk of impairment to the main trunk of these nerves, but there are 24%chances of damage to the superficial fibular nerve or the intermediate dorsal cutaneous nerve of the foot at the level of the anterior margin of the lateral malleolus and 10%chances of damage to sural nerve at the tip of the malleolus. The anaesthetic area can be extremely variable after the in