Solomon Lucian B, Ferris Linda, Henneberg Maciej
Department of Orthopaedics, Royal Adelaide Hospital, SA, Australia.
ANZ J Surg. 2006 Oct;76(10):932-6. doi: 10.1111/j.1445-2197.2006.03909.x.
This article evaluates the risk of interference with the neurovascular structures in the four anterior ankle arthroscopic portals, described on each side of the extensor tendons: anteromedial, medial midline, anterocentral and anterolateral. Complications after ankle arthroscopies have been described in up to 17%, most being neurovascular. To quantify the neurovascular risks we dissected 68 cadaveric feet and evaluated the correlations between tendons, vessels and nerves. The mean distance between tibialis anterior and extensor hallucis longus and between extensor hallucis longus and extensor digitorum longus is 4 mm, but in 10-20% these tendons are in apposition or are overlapped. The tibialis anterior vascular bundle was absent in 11.8%, was located between the tibialis anterior and the extensor hallucis longus in 3% and between the extensor hallucis longus and the extensor digitorum longus in 64.7%. A peroneal vascular bundle or branches of the tibialis anterior vascular bundle were located lateral to the extensor digitorum longus/peroneus tertius tendon in 88.2%. Transverse vascular branches were identified in 41.2% over the medial side of the joint line and in 52.9% over the lateral side. The deep peroneal nerve was located between the extensor hallucis longus and the extensor digitorum longus tendons in 58.8%. The superficial peroneal nerve had branches located between the tibialis anterior and the extensor hallucis longus tendons in 2.9%, between the extensor hallucis longus and the extensor digitorum longus tendons in 23.5% and lateral to the extensor digitorum longus/peroneus tertius tendon in 32.4%. These results show that the anteromedial and medial midline portals are the safest. The anterolateral portal should be noted not only for the risks to the superficial peroneal nerve, but also to the peroneal vessels.
本文评估了位于伸肌腱两侧的四个踝关节前侧关节镜入路对神经血管结构的干扰风险，这四个入路分别为：前内侧、内侧中线、前中央和前外侧。踝关节镜检查后的并发症发生率高达17%，其中大多数为神经血管并发症。为了量化神经血管风险，我们解剖了68只尸体足，并评估了肌腱、血管和神经之间 的相关性。胫骨前肌与拇长伸肌之间以及拇长伸肌与趾长伸肌之间的平均距离为4mm，但在10%-20%的情况下，这些肌腱相互贴靠或重叠。11.8%的标本中不存在胫骨前肌血管束，3%位于胫骨前肌与拇长伸肌之间，64.7%位于拇长伸肌与趾长伸肌之间。88.2%的标本中，腓血管束或胫骨前肌血管束的分支位于趾长伸肌/第三腓骨肌腱外侧。在关节线内侧41.2%的标本以及外侧52.9%的标本中发现了横行血管分支。58.8%的标本中，腓深神经位于拇长伸肌与趾长伸肌肌腱之间。2.9%的标本中，腓浅神经的分支位于胫骨前肌与拇长伸肌肌腱之间，23.5%位于拇长伸肌与趾长伸肌肌腱之间，32.4%位于趾长伸肌/第三腓骨肌腱外侧。这些结果表明前内侧和内侧中线入路是最安全的。前外侧入路不仅要注意腓浅神经的风险，还要注意腓血管的风险。
