Bodily Kale D, Spinner Robert J, Bishop Allen T
Mayo Medical School, Mayo Foundation, Rochester, Minnesota 55905, USA.
Clin Anat. 2004 Apr;17(3):201-5. doi: 10.1002/ca.10189.
Traction injuries of the common fibular (peroneal) nerve frequently result in significant morbidity due to tibialis anterior muscle paralysis and the associated loss of ankle dorsiflexion. Because current treatment options are often unsuccessful or unsatisfactory, other treatment approaches need to be explored. In this investigation, the anatomical feasibility of an alternative option, consisting of nerve transfer of motor branches from the tibial nerve to the deep fibular nerve, was studied. In ten cadaveric limbs, the branching pattern, length, and diameter of motor branches of the tibial nerve in the proximal leg were characterized; nerve transfer of each of these motor branches was then simulated to the proximal deep fibular nerve. A consistent, reproducible pattern of tibial nerve innervation was seen with minor variability. Branches to the flexor hallucis longus and flexor digitorum longus muscles were determined to be adequate, based on their branch point, branch pattern, and length, for direct nerve transfer in all specimens. Other branches, including those to the tibialis posterior, popliteus, gastrocnemius, and soleus muscles were not consistently adequate for direct nerve transfer for injuries extending to the bifurcation of the common fibular nerve or distal to it. For neuromas of the common fibular nerve that do not extend as far distally, branches to the soleus and lateral head of the gastrocnemius may be adequate for direct transfer if the intramuscular portions of these nerves are dissected. This study confirms the anatomical feasibility of direct nerve transfer using nerves to toe-flexor muscles as a treatment option to restore ankle dorsiflexion in cases of common fibular nerve injury.
由于胫前肌麻痹及相关的踝关节背屈丧失，腓总神经牵拉伤常导致严重的功能障碍。鉴于目前的治疗方法往往不成功或不尽人意，需要探索其他治疗途径。在本研究中，对一种替代方案的解剖学可行性进行了研究，该方案是将胫神经的运动支转移至腓深神经。在10具尸体下肢中，对小腿近端胫神经运动支的分支模式、长度和直径进行了特征描述；然后将这些运动支逐一模拟转移至腓深神经近端。观察到胫神经支配模式一致且可重复，变异较小。根据拇长屈肌和趾长屈肌分支的分支点、分支模式和长度，确定其在所有标本中均适合直接神经转移。对于延伸至腓总神经分叉处或更远端的损伤，包括胫后肌、腘肌、腓肠肌和比目鱼肌的其他分支，通常不适合直接神经转移。对于未向远端延伸的腓总神经神经瘤，如果解剖这些神经的肌内部分，腓肠肌外侧头和比目鱼肌的分支可能适合直接转移。本研究证实了在腓总神经损伤病例中，使用支配趾屈肌的神经进行直接神经转移以恢复踝关节背屈作为一种治疗选择的解剖学可行性。
