踝前区的应用解剖

Applied anatomy of the front part of ankle

目的 为大隐静脉切开术及隐神经、腓浅神经阻滞麻醉的顺利进行提供形态学资料。方法 在64例成人整尸的128侧下肢观察大隐静脉、隐神经和腓浅神经等结构在踝前的位置及与邻近结构的关系;测量大隐静脉、足背动脉等血管的外径,隐神经等神经的厚度、宽度及深度,它们与内、外踝,胫骨前肌腱等结构的距离及彼此之间的距离。结果与结论 ①大隐静脉经内踝前外侧上行至小腿,在内踝平面位置表浅而恒定,是理想的静脉切开的部位;大隐静脉距内踝前缘最突出点约1cm,距胫骨前肌腱约1.5cm,且关系较恒定,可以此二结构作为大隐静脉的标志,多数情况静脉通过此二结构连线内侧2/5与外侧3/5交点的深面。②腓浅神经均于浅筋膜内经踝关节前方下行分布于足背、趾背皮肤,在踝前均行于足背动脉外侧,可用动脉搏动点作为神经阻滞定位标志;多数情况为腓浅神经的两终支经踝关节前方下降,故阻滞时最好在踝间连线平面从动脉搏动点进针向外踝方向注药同时阻滞两个终支。③腓深神经虽然分布于皮肤的范围很窄,但可能与腓浅神经有吻合,故作腓浅神经阻滞时最好同时阻断腓深神经;腓深神经与足背动脉伴行,阻滞时以动脉作标志即可。④足背动脉在踝前位置较恒定,恰位于两踝间中点,可作为踝前神经阻滞的标志点。

Objective To provide the morphological data for operation of venesection of great saphenous vein, and block anesthesia of sa-phenous nerve and superficial peroneal nerve. Methods On 128 pieces of lower limbs from 64 corpes (41 of male and 23 of female), The position and their relations with neighbouring structures of great saphenous vein, saphenous nerve and superficial peroneal nerve in the front part of ankle were observed. The outer diameter of great saphenous vein and dorsal artery of foot, the width, thickness and depth of saphenous nerve and the distance between these structures and medial and lateral malleolus, tendon of tibialis anterior were measared. Results and Conclusion ① At the level of medial malleolus, great saphenous vein was located superficially and constanty and was an optimal site for venesection. Great saphenous vein was about 1 cm and 1.5 cm away from the outmost point of the front edge of medial malleolus and tendon of tibialis anterior respectively, and in most cases the vein passes through underneath the point dividing the medial 2/5 and lateral 3/5 part of the line between the two structures, these marks could beused as the mark of great saphenous vein. ②Superficial peroneal nerve was along the external side of dorsal artery of foot when passing through the front of ankle joint. In most cases both terminal branches of superficial peroneal nerve pass downwards throuhg the front of ankle joint. When block anesthesia is needed the injection should be administered at the level of medial-lateral malleolus line, with the needle pointed from the site of arterial pulse to lateral malleolus, to block the terminal branches. ③Deep peroneal nerve may anastomose with superficial peroneal nerve. In case of blocking superficial peroneal nerve, it is advisable to block the deep peroneal nerve at the same time. This may be achieved by using the dorsal artery as a mark. ④Dorsal artery of foot is constantly located at the middle-point of medial-lateral malleolus line, and is a good mark for blocking the nerves in the front of ankle.