Identifying the emergence of the superficial peroneal nerve through deep fascia on ultrasound and by dissection: Implications for regional anesthesia in foot and ankle surgery
Identifying the emergence of the superficial peroneal nerve through deep fascia on ultrasound and by dissection: Implications for regional anesthesia in foot and ankle surgery
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DOI：
10.1002/ca.23323
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发表时间：
2019-04-01
期刊：
影响因子：
2.4
通讯作者：
Varsou, Ourania
中科院分区：
文献类型：
--
作者：
Bowness, James;Turnbull, Katie;Varsou, Ourania
区域麻醉依赖于对解剖结构的正确理解和超声在识别相关结构中的应用。我们评估了26名志愿者（平均年龄27.85岁± 13.186岁;男女相等）通过超声识别腓浅神经（SPN）穿过深筋膜的位置的能力。确定该点，并与周围骨标志（外踝和腓骨头）进行表征，并与16具福尔马林固定的人尸体（平均年龄82.88岁+/- 6.964;男性：女性相等）的数据进行比较。所有受试者的SPN均在双侧确定。在超声检查中，发现在从外踝到腓骨头的直线（LM-HF线）上沿着的0.31（+/- 0.066）点处刺穿腿部深筋膜。在所有情况下，这都发生在线上或线前。尸体解剖发现该点沿LM-HF线为0.30（+/- 0.062）沿着，两组之间无统计学显著差异（U = 764.000;精确双尾P = 0.534）。其始终位于LM-HF线上或前方，超声检查时前方0.74 cm（+/- 0.624），解剖过程中前方1.51 cm（+/- 0.509）。在尸体中，该点明显更靠前于LM-HF线（U = 257.700，精确双尾P < 0.001）。解剖显示46.88%（n = 15）的肢体在出现前神经分裂，超声未识别（尽管未具体评估）。当患者因素（例如，肥胖和外周水肿）使得超声引导的神经定位在技术上更具挑战性。临床解剖学32：390-395，2019年。(c)2019 Wiley Periodicals，Inc.
Regional anesthesia relies on a sound understanding of anatomy and the utility of ultrasound in identifying relevant structures. We assessed the ability to identify the point at which the superficial peroneal nerve (SPN) emerges through the deep fascia by ultrasound on 26 volunteers (mean age 27.85 years +/- 13.186; equal male: female). This point was identified, characterized in relation to surrounding bony landmarks (lateral malleolus and head of the fibula), and compared to data from 16 formalin-fixed human cadavers (mean age 82.88 years +/- 6.964; equal male: female). The SPN was identified bilaterally in all subjects. On ultrasound it was found to pierce the deep fascia of the leg at a point 0.31 (+/- 0.066) of the way along a straight line from the lateral malleolus to the head of the fibula (LM-HF line). This occurred on or anterior to the line in all cases. Dissection of cadavers found this point to be 0.30 (+/- 0.062) along the LM-HF line, with no statistically significant difference between the two groups (U = 764.000; exact two-tailed P = 0.534). It was always on or anterior to the LM-HF line, anterior by 0.74 cm (+/- 0.624) on ultrasound and by 1.51 cm (+/- 0.509) during dissection. This point was significantly further anterior to the LM-HF line in cadavers (U = 257.700, exact two-tailed P < 0.001). Dissection revealed the nerve to divide prior to emergence in 46.88% (n = 15) limbs, which was not identified on ultrasound (although not specifically assessed). Such information can guide clinicians when patient factors (e.g., obesity and peripheral edema) make ultrasound-guided nerve localization more technically challenging. Clin. Anat. 32:390-395, 2019. (c) 2019 Wiley Periodicals, Inc.