Mochizuki T, Akita K, Muneta T, Sato T
Section of Orthopedic Surgery, Division of Bio-Matrix, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan.
Surg Radiol Anat. 2003 Jul-Aug;25(3-4):192-9. doi: 10.1007/s00276-003-0130-1. Epub 2003 Jun 19.
The aim of this study was to improve surgical techniques for arthroscopically-assisted anterior cruciate ligament (ACL) reconstruction with minimal sensory disturbance in the infrapatellar and anterior lower leg regions. Thirteen patients with sensory disturbance were examined neurologically, and 51 lower limbs of 26 adult cadavers were examined anatomically to investigate the nerve branches supplying the regions. The region of sensory disturbance was supplied by branches of the medial femoral cutaneous nerve and the saphenous nerve, and the nerves showed a complementary distribution area. After detailed investigation of the positional relationships between the nerve branches and the skin incisions of the operative procedure, it was found that at least one branch of both nerves ran across the longitudinal skin incision (80%) for tendon harvest in the above-mentioned reconstruction. The complicated anatomic variations of the nerve branches preclude their absolute avoidance in any surgical incision, and a completely safe zone could not be found in the present study. However, an oblique incision for the tendon harvest rather than the typical longitudinal incision should be considered to minimize the sensory disturbance.
本研究的目的是改进关节镜辅助下前交叉韧带（ACL）重建的手术技术，使髌下和小腿前侧区域的感觉干扰最小化。对13例有感觉障碍的患者进行了神经学检查，并对26具成年尸体的51条下肢进行了解剖学检查，以研究供应这些区域的神经分支。感觉障碍区域由股内侧皮神经和隐神经的分支供应，且这些神经显示出互补的分布区域。在详细研究神经分支与手术操作皮肤切口之间的位置关系后发现，在上述重建手术中，至少有一条来自这两条神经的分支会穿过用于取腱的纵向皮肤切口（80%）。神经分支复杂的解剖变异使得在任何手术切口中都无法绝对避免它们，并且在本研究中未发现完全安全的区域。然而，为了将感觉干扰降至最低，应考虑采用斜切口取腱而非典型的纵向切口。
