膝关节外侧疼痛诊疗的外侧支持带神经定位及应用解剖研究

The anatomical study of location and application of lateral retinacular nerve in the diagnosis and treatment of lateral knee pain

目的观察并测量外侧支持带神经(lateral retinacular nerve,LRN)的临床解剖学参数,探讨LRN的体表定位方法,为膝关节前外侧疼痛的诊治提供解剖依据。方法随机选取17具正常成年尸体下肢(34侧)进行解剖,确定坐骨神经(sciatic nerve,SN)的位置、走形和主要分支,选取位于膝关节后方的分支膝上外侧神经(SLGN)进行研究。追踪SLGN走形确认其第一个分支LRN,测量LRN分叉点分别到外侧胫股关节关节线与股骨外上髁的外侧端两个测量点的距离,从而确定LRN在体表的定位标志,并验证其准确性。结果LRN分叉点到第1个测量点的平均距离为(55.00±3.22)mm,到第2个测量点(26.00±2.42)mm。有性别差异,男性LRN分叉点到第1测量点平均(57.00±3.64)mm,到第2测量点平均(27.00±2.72)mm;女性分别为(51.00±1.14)mm,(23.00±0.54)mm。对两个定位标志的准确性评估,第1测量点(55.00 mm)准确率为100%,第2测量点(26.00 mm)准确率为67%。结论LRN在体表有两个较为可靠的定位标志,准确定位LRN并描述其路径,可以为诊治外侧膝关节疼痛提供理论依据。

Objective To observe and measure the lateral retinacular nerve(LRN)in order to facilitate diagnostic and therapeutic nerve block and treatment for anterolateral knee pain.Methods Total34 lower limbs had been dissected from 17 normal adult specimens.The exact location and main branches of the sciatic nerve(SN)were observed by specimen dissection.The posterior branch of the knee,superior lateral genicular nerve(SLGN)was dissected.Its first branch LRN was determined by tracing to the end.The first measurement point was the position from LRN branch of SLGN to the lateral tibiofemoral knee line.The second measurement point was the position from LRN branch of SLGN to the top of the external epicondyle of femur.Results The average distance of the first measuring point was(55.00±3.22)mm.The average distance of the second measuring point was(26.00±2.42)mm.There was gender differences.In which,the average distance of the first measurement point in male was(57.00±3.64)mm,and the average distance of the second measurement point in male was(27.00±2.72)mm.The average distance of the two measurement points in female was(51.00±1.14)mm,(23.00±0.54)mm,respectively.The evaluation of the two measurement points showed that,the probability of the first measurement point locating in knee joint was100%,while the probability of the second measurement point locating in knee joint was 67%.Conclusions The study provides two dependable landmarks and a description of the path of the LRN making it possible to target the lateral retinacular nerve to diagnose and alleviate lateral knee pain.