膝关节神经分布的解剖学研究及其临床意义

Clinical anatomyof the innervation of knee joint

目的:为膝关节疼痛的诊断及手术治疗提供局部神经支配的解剖形态学基础。方法:对80例成人下肢标本膝关节神经分布进行解剖观测。结果:支配膝关节的神经可分为浅、深2层。浅层为皮神经,部分干较粗,容易形成皮神经瘤;深层可以分为伸膝肌支膝关节支组成的髌上区组,隐神经分支组成的内侧及髌下区组,腓总神经关节支组成的后外侧区组,月国丛神经组成的月国区组4组。4组神经在关节囊外分布有重叠交叉,但区域明确。深层的隐神经膝关节支、腓总神经膝关节支和股内侧肌支膝关节支等神经支粗约1mm,位置表浅且固定,具有选择性切断的可行性。结论:TKA、膝关节镜等术中通过滑膜切除、关节支切断进行髌骨周围去神经化术对降低髌股关节疼痛有合理的解剖机制;膝关节局部去神经化术对确诊局部皮神经瘤形成或神经支卡压等关节外源性疼痛具有可行性。

Objective： To explore the innervation of knee joint and the possibility of neurotomy to treat the arthronalgia of knee joint. Methods： The nerve branches of 80 cadaver knees were dissected and measured. Results： The innervation＇pattern of the study was similar to that of Homers. But our study suggested that the innervation of knee joint had two layer groups ： the superficial layer group and the profunda layer group. The superficial layer was composed of the cutaneous nerves which may form nerve tumor easily. The profunda layer group could be further divided into 4 groups which comprised different articular branches respectively, although they had some extent superimpose innervation outside the articular capsule, each one had its special distribution area, With the coverage and extension of synovial membranes, an extensive network of somatic nerve and autonomic nerve founded in the capacity of knee joint. The articular branches of saphenous nerve , common peroneal nerve and the muscular branches of quadriceps muscle never were mostly about lmm thickness, and could be located easily. Conclusion： Denervation have the rational anatomical foundation to relieve the pain in patellofemoral joint. Arthronalgia can be relieved by resetting the membrane synovialis and articular braches through total knee arthroplasty or arthroscopy. Selective denervation technique may be effective to some extrinsic source pain due to the regional cutaneous nerve neoplasia or nerve branch compression.