Dunaway Daniel J, Steensen Robert N, Wiand William, Dopirak Ryan M
Department of Orthopaedic Surgery, Mount Carmel Health System, Columbus, Ohio 43222, USA.
Arthroscopy. 2005 May;21(5):547-51. doi: 10.1016/j.arthro.2005.02.019.
Injury to the saphenous nerve accounts for the majority of neurovascular complications during arthroscopic meniscal repairs. Although the anatomy of the infrapatellar branch has been studied, the location of the sartorial branch at the level of the joint line has not been defined adequately. The purpose of this study was to define the location of the sartorial branch in relation to surrounding structures at the level of the knee joint/meniscus.
Cadaveric anatomic study and imaging study.
We dissected 42 cadaveric knees and studied an additional 100 knees with axial magnetic resonance imaging (MRI). We measured distances from the nerve to adjacent structures and evaluated and graphically recorded 2-dimensional axial relationships. Dissections and MRIs were performed with the knee in full extension.
In the dissected cadaveric knees, the distance from the nerve to the anterior border of the sartorius averaged 16.0 mm, with 90% greater than 10.0 mm. The nerve was extrafascial at the joint line in only 43% of the specimens. Axial MRI examinations found the average distance to the anterior border of the sartorius to be 16.5 mm, with 82% greater than 1.0 cm. The average distance to the gracilis tendon was 9.4 mm; 91% were within 1.0 cm and 51% within 5 mm. The average distance to the semitendinosus was 14.9 mm; none was within 5 mm. The nerve was never posterior or lateral to the semitendinosus, never posterolateral or lateral to the gracilis, and was anterior to the sartorius in only 3% of knees.
This study describes the most common location of the sartorial branch of the saphenous nerve and the potential variability that may be encountered.
Understanding the anatomy of the sartorial branch at the level of the joint line and its relationships to surrounding structures will help to minimize the risk of injury to the nerve during common surgical procedures at the posteromedial corner of the knee.
隐神经损伤是关节镜下半月板修复术中大多数神经血管并发症的原因。虽然髌下支的解剖结构已被研究，但缝匠肌支在关节线水平的位置尚未得到充分界定。本研究的目的是确定缝匠肌支在膝关节/半月板水平与周围结构的位置关系。
尸体解剖研究和影像学研究。
我们解剖了42具尸体膝关节，并对另外100具膝关节进行了轴向磁共振成像（MRI）研究。我们测量了神经到相邻结构的距离，并评估和以图形方式记录了二维轴向关系。解剖和MRI检查均在膝关节完全伸展时进行。
在解剖的尸体膝关节中，神经到缝匠肌前缘的平均距离为16.0毫米，90%大于10.0毫米。在仅43%的标本中，神经在关节线处位于筋膜外。轴向MRI检查发现，到缝匠肌前缘的平均距离为16.5毫米，82%大于1.0厘米。到股薄肌腱的平均距离为9.4毫米；91%在1.0厘米以内，51%在5毫米以内。到半腱肌的平均距离为14.9毫米；无一在5毫米以内。神经从未位于半腱肌后方或外侧，从未位于股薄肌后外侧或外侧，仅在3%的膝关节中位于缝匠肌前方。
本研究描述了隐神经缝匠肌支最常见的位置以及可能遇到的潜在变异性。
了解关节线水平缝匠肌支的解剖结构及其与周围结构的关系，将有助于在膝关节后内侧角的常见手术过程中尽量减少神经损伤的风险。
