Surgical Anatomy of the Superficial Peroneal Nerve in the Ankle and Foot
Surgical Anatomy of the Superficial Peroneal Nerve in the Ankle and Foot
复制标题
踝关节和足部腓浅神经的外科解剖
DOI：
10.1097/00003086-199408000-00028
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发表时间：
1994
影响因子：
4.2
通讯作者：
M. Botte
中科院分区：
文献类型：
--
作者：
John M. Blair;M. Botte
在放大镜下解剖25具尸体下肢腓浅神经的皮下（感觉）部分。注意到三种不同的分支模式类型。A型（72%）包括神经在距踝关节近端平均12.3 cm处穿透脚筋膜成为皮下神经，然后在距踝关节近端平均4.4 cm处分为两个主要分支：大的内侧背皮神经和较小的外侧背皮神经中间。B型（16%）由内侧和中间背皮神经独立于腓浅神经形成的模式组成，内侧背皮神经的走行与a型相似，而内侧背皮神经在距踝关节近端5.5 cm处穿过腓骨后的脚筋膜，并在距踝关节上方平均4.5 cm处向内侧走行穿过腓骨外侧。C型（12%）包括内侧背皮神经和中间背皮神经独立出现，内侧背皮神经走行与a型相似；然而，中间背皮神经穿过腓骨前的脚筋膜，平均在踝关节以上4.9厘米处，并继续靠近腓骨前缘。踝关节内侧背皮神经和中间背皮神经的平均直径分别为2.9 mm和2 mm。内侧背皮神经位于外踝到内踝距离的一半左右而中间背皮神经位于外踝到内踝距离的三分之一左右。了解这些分支模式和量化的关系有助于外科手术过程中的神经保护，也有助于快速分离神经进行探查或减压。尤其具有医源性损伤风险的分支包括：(1)B型中间背皮神经，该神经穿过腓骨远端外侧表面；(2) C型中间背皮神经，该神经靠近腓骨前缘；(3)踝关节水平的中间背皮神经和内侧背皮神经，在踝关节前切开术或关节镜检查时，它们是危险的。
The subcutaneous (sensory) portion of the superficial peroneal nerve was dissected in 25 cadaver lower limbs under loupe magnification. Three distinct branching pattern types were noted. Type A (72%) consisted of a pattern where the nerve penetrated the crural fascia to become subcutaneous at an average distance of 12.3 cm proximal to the ankle joint, then divided at a mean distance of 4.4 cm proximal to the ankle into two major branches: a large medial dorsal cutaneous nerve and a smaller more laterally located intermediate dorsal cutaneous nerve. Type B (16%) consisted of a pattern where both the medial and intermediate dorsal cutaneous nerve arose independently from the superficial peroneal nerve, with the medial dorsal cutaneous nerve having a similar course to that found in Type A, while the intermediate dorsal cutaneous nerve penetrated the crural fascia posterior to the fibula 5.5 cm proximal to the ankle joint and coursed medially to cross the lateral aspect of the fibula at mean distance 4.5 cm above the ankle joint. Type C (12%) consisted of a pattern where the medial dorsal cutaneous nerve and the intermediate dorsal cutaneous nerve arose independently and the medial dorsal cutaneous nerve coursed similar to that in Type A; however, the intermediate dorsal cutaneous nerve penetrated the crural fascia anterior to the fibula an average of 4.9 cm above the ankle joint and continued in close proximity to the anterior fibular border. In all patterns the mean diameters of the medial dorsal cutaneous nerve and intermediate dorsal cutaneous nerve at the ankle were 2.9 mm and 2 mm, respectively. At the level of the malleoli, the medial dorsal cutaneous nerve was located approximately one half the distance from the lateral malleolus to medial malleolus while the intermediate dorsal cutaneous nerve was approximately one third the distance. Appreciation of these branch patterns and the quantified relationships should assist nerve protection during surgical procedures as well as aid rapid nerve isolation for exploration or decompression. Branches especially at risk for iatrogenic injury include: (1) the intermediate dorsal cutaneous nerve of Type B where the nerve crosses the lateral surface of the distal fibula; (2) the intermediate dorsal cutaneous nerve of Type C where the nerve travels adjacent to the anterior border of the fibula; and (3) the intermediate dorsal cutaneous nerve and the medial dorsal cutaneous nerve at the level of the ankle, where they are at risk during anterior ankle arthrotomy or arthroscopy.