Vloka J D, Hadzić A, April E, Thys D M
Department of Clinical Anesthesiology, St. Luke's-Roosevelt Hospital Center, New York, New York 10025, USA.
Anesth Analg. 2001 Jan;92(1):215-7. doi: 10.1097/00000539-200101000-00041.
The sciatic nerve (SN) originates from the L4-S3 roots in the form of two nerve trunks: the tibial nerve (TN) and the common peroneal nerve (CPN). The TN and CPN are encompassed by a single epineural sheath and eventually separate (divide) in the popliteal fossa. This division of the SN occurs at a variable level above the knee and may account for frequent failures reported with the popliteal block. We studied the level of division of the SN in the popliteal fossa and its relationship to the common epineural sheath of the SN. The level of division of the SN sheath into TN and CPN above the knee was measured in 28 cadaver leg specimens. The SN was invariably formed of independent trunks (TN and CPN) encompassed in one common epineural sheath. The SN divided at a mean distance of 60.5 +/- 27.0 mm (range 0 to 115 mm) above the popliteal fossa crease. We conclude that the TN and CPN leave the common SN sheath at variable distances from the popliteal crease. This finding and the relationship of the TN and CPN sheaths may have significant implications for popliteal block.
When performing popliteal block, insertion of the needle at 100 mm above the popliteal crease is more likely to result in placement of the needle proximal to the division of the sciatic nerve than placement at 50 or 70 mm, according to the classical teaching.
坐骨神经（SN）以两条神经干的形式起源于L4 - S3神经根：胫神经（TN）和腓总神经（CPN）。胫神经和腓总神经被单个神经外膜鞘包裹，最终在腘窝处分开（分叉）。坐骨神经的这种分叉发生在膝关节上方的不同水平，这可能是腘窝阻滞报道中频繁失败的原因。我们研究了坐骨神经在腘窝处的分叉水平及其与坐骨神经共同神经外膜鞘的关系。在28个尸体腿部标本中测量了坐骨神经鞘在膝关节上方分叉为胫神经和腓总神经的水平。坐骨神经总是由包裹在一个共同神经外膜鞘中的独立神经干（胫神经和腓总神经）组成。坐骨神经在腘窝皱襞上方平均距离60.5±27.0毫米（范围0至115毫米）处分叉。我们得出结论，胫神经和腓总神经在距腘窝皱襞不同距离处离开共同的坐骨神经鞘。这一发现以及胫神经和腓总神经鞘的关系可能对腘窝阻滞有重要意义。
根据传统教学，在进行腘窝阻滞时，在腘窝皱襞上方100毫米处进针比在50或70毫米处进针更有可能将针放置在坐骨神经分叉近端。
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