外踝术中腓肠神经和腓浅神经的应用解剖

Applied Anatomy of the Sural and Superficial Fibular Nerves during the Surgical Approach to the Lateral Malleolus

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。方法 在解剖显微镜下对 5 0侧常规防腐固定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。结果 2 4 % (12侧 )的腓浅神经或足背中间皮神经浅出点在外踝前缘水平 ,10 % (5侧 )的腓肠神经横切过外踝尖 ,78% (39侧 )的标本可识别来自这两条神经的踝支 (其中 2 8%同时具有两个来源 ) ,腓肠神经管理 38% (19侧 )标本的足及足趾的外侧半。结论 外踝术中很容易损伤来自腓肠神经和腓浅神经的踝支 (可能性为 78% ) ,损伤神经主干的风险较小 ,但有 2 4 %的可能损伤在外踝前缘浅出的腓浅神经或足背中间皮神经 ,10 %的可能损伤外踝尖处的腓肠神经 ,而且损伤后感觉缺失范围差异很大 。

Objective To investigate the risk and to analyse the anaethetic area of laceration of the sural and superficial fibular nerves during the surgical approach to the lateral malleolus. Methods The sural and the superficial fibular nerves,and their branches in 50 sides embalmed leg-ankle-foot specimens were dissected,measured and drawn under the anatomic microscop.Results In 24% of specimens the superficial fibular nerve or the intermediate dorsal cutaneous nerve of the foot pierced the deep fascia at the level of the anterior margin of the malleolus. In 7 cases (10%) the sural nerve was tangent to the tip of the malleolus. Malleolar nerve branches were identified in 78% of the sides (in 28% from both sources). The sural nerve supplies the superficial innervation to the lateral half of the foot and toes in 42% of cases. Conclusion The risk of laceration of malleolar branches from both the sural and the superficial fibular nerves is highduring the approach to the lateral malleolus. There is less risk of damage to the main trunk of these nerves, but the 24% chance of laceration of the superficial fibular nerveat the level of the anterior margin of the malleolus andthe 10% chance of laceration of sural nerve at the tip of the malleolus is significant. Theanaesthetic area of laceration of nerves can be extremely variable,and the risk of laceration of sural nerve is even more important than indicated by the common anatomical teaching.