Injection Inside the Paraneural Sheath of the Sciatic Nerve Direct Comparison Among Ultrasound Imaging, Macroscopic Anatomy, and Histologic Analysis
Injection Inside the Paraneural Sheath of the Sciatic Nerve Direct Comparison Among Ultrasound Imaging, Macroscopic Anatomy, and Histologic Analysis
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DOI：
10.1097/aap.0b013e31825145f3
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发表时间：
2012-07-01
影响因子：
5.1
通讯作者：
Tranum-Jensen, Jorgen
中科院分区：
文献类型：
--
作者：
Andersen, Henning Lykke;Andersen, Sofie L.;Tranum-Jensen, Jorgen
背景和目的：关于腘窝坐骨神经鞘的结构和超声特征的解剖学知识很少。我们研究了注射在鞘内的扩散，以(1)确定鞘是与神经或神经外膜的一部分不同的结构，(2)开发超声引导注射技术。方法：采用大体解剖、超声检查、组织学研究等方法，对28例尸体腿的腘窝坐骨神经周围组织层进行特征分析。结果：大体而言，我们发现神经外膜周围有一层薄、透明、脆弱的组织层。超声检查发现，这一层与注射层是高回声层，从坐骨神经表面分离。组织学上，鞘被视为多层圆形筋膜，是神经旁组织的一部分。鞘内注射10ml，沿着神经扩散10 - 15厘米，但不是完全环绕，如果注射在鞘外，则为5 - 6厘米。介绍了超声引导注射技术的特点。结论：在腘窝坐骨神经周围有明显的组织层，作为神经鞘，具有明显的大体解剖、组织学和超声特征。这种鞘可能对涉及腘窝坐骨神经的区域麻醉有影响。我们建议，超声引导注射技术可以用于未来的临床研究，研究神经旁鞘的重要性。
Background and Objectives: There exists little anatomic knowledge regarding the structure and sonographic features of the sheath enveloping the sciatic nerve in the popliteal fossa. We investigated the spread of an injection inside the sheath to (1) determine whether the sheath is a structure distinct from the nerve or part of the epineurium and (2) to develop an ultrasound-guided injection technique.Methods: Using gross dissection, ultrasound examination, and histologic study, we characterized the tissue layer surrounding the sciatic nerve in the popliteal fossa of 28 unembalmed cadaver legs.Results: Grossly, we identified a thin, transparent, and fragile tissue layer surrounding the epineurium. Sonographically, this layer was identified with injectate as a hyperechoic layer detaching from the surface of the sciatic nerve. Histologically, the sheath was seen as a multilayered circular fascia as part of the paraneural tissue. An injection of 10 mL inside the sheath spread 10 to 15 cm closely along the nerve, however, not completely circumferential, compared with 5 to 6 cm if the injection was outside the sheath. Characteristics of the ultrasound-guided injection technique are described.Conclusions: There is a distinct tissue layer surrounding the popliteal sciatic nerve as a paraneural sheath that has distinct gross anatomic, histologic, and sonographic features. This sheath may have implications for regional anesthesia involving the popliteal sciatic nerve. We suggest that the ultrasound-guided injection technique described here could be used in future clinical studies investigating the importance of the paraneural sheath.