选择性腓肠肌内、外侧头肌支切断小腿减肥术中解剖观察及应用效果

Anatomic study and clinical effect of the selective neurotomy of medial and lateral heads of muscular branches to gastrocnemius on calf reducetion

目的:探索将腓肠肌内、外侧头肌支神经切断,腓肠肌失神经萎缩,改善小腿肌性肥大外形的方法及效果。方法:对9例腓肠肌肌性肥大女性18侧小腿行选择性胫神经腓肠肌内、外侧头肌支切断小腿减肥术,术中观测腓肠肌内、外侧头神经肌支在胫神经起点位置及与相邻神经的位置关系,测量小腿外形及周径变化。结果:(1)腓肠肌内、外侧头肌支在胫神经上的起点位置较恒定,在月国窝中点上下1.5cm范围内;(2)腓肠肌内、外侧头肌支起始与比目鱼肌支、腓肠内侧皮神经临床所见有4种组合关系,提示尽可能在神经支进入内、外侧腓肠肌肌门处选择性切断更为安全;(3)9例受术者术后早期可以行走、站立,无明显肿胀,随访3个月至1年,下肢无任何功能障碍,活动如常,小腿最大周径平均缩减(4.2±1.2)cm。小腿曲线变平缓,以内侧缩小明显。结论:(1)行选择性胫神经腓肠肌内、外侧头肌支切断术,可缩小小腿肌性肥大症状,达到小腿减肥,改善小腿外形之目的,效果明显;(2)该术式安全,简便,不影响受术者行走功能。

Objective： To explore the possibility of reducing the volume of gastrocnemius muscle for calf reduction by neurotomy of the nerve to medial and lateral heads of the gastrocnemius muscle. Methods： Neurotomy of the nerve to medial and lateral heads of the gastrocnemius muscle was performed in 9 cases（ 18 side）. The origining points of medial and lateral branches from tibial nerve and their relationship with other nerves was observed. The circumference and the shape of the calf were measured and observed. Results： （ 1 ） Branches to the medial and lateral heads of gastrocnemius arised from the tibial nerve, at a limited region no more than 1.5cm around the centre of the popliteal fossa. （2）The medial and lateral branches firmly related with the muscular branches reaching to soleus and the medial sural cutaneous nerve, which shown that it could be more safety to cut them where the branches entered into the hilums of the heads of the gastrocnemius muscle. （3）Neurotomy of the nerve to medial and lateral heads of the gastrocnemius muscle was performed in 9 cases. After operation, the circumference of the leg reduced about （4.2± 1.2）cm averagely and the curve of the calf reduced too. There was no obvious swelling in all cases and patients can walk immediately after operation. The function of the leg was not obviously influenced according the following up data from 3 months to 1 year. Concltions ： （ 1 ）Neurotomy of the nerve to medial and lateral heads of gastrocnemius muscle could reduce the volume of gastrocnemius muscle. （2）This method is safe and simple,and do not effect walking function of patients.