Citak Musa, Knobloch Karsten, Albrecht Knut, Krettek Christian, Hufner Tobias
Trauma Department, Hannover Medical School, Hannover, Germany.
Br J Sports Med. 2007 Jul;41(7):456-8; discussion 458. doi: 10.1136/bjsm.2006.031328. Epub 2007 Mar 8.
Sural nerve injuries are an evident risk especially of minimal-invasive surgical Achilles tendon repair. However, detailed anatomical studies focusing on the relationship of the sural nerve with the Achilles tendon at various levels are scarce, even pending in two planes.
To determine the position and course of the sural nerve in relation to the Achilles tendon in two planes after trans-section and computer-assisted determination.
The exact course of the sural nerve was determined in 10 cadavers (55.3 years, 19-89 years), using a computer-assisted method in two planes (transversal/sagittal).
The sural nerve crossed the Achilles tendon at 11 (8.7-12.4) cm proximal to the tuber calcanei. The distance between the lateral crossing and the proximal musculotendineus junction was 35 (20-58) mm. Starting from the tuber calcanei, the distance was 2/2 mm (transversal/sagittal plane) at 11 cm proximal to the tuber calcanei, 4/4 mm at 10 cm proximal, 5/6 mm at 9 cm, 8/10 mm at 5 cm and 11/18 mm at the tuber calcanei.
In the lateral crossing region of the sural nerve and the lateral proximal Achilles tendon 9-12 cm proximal to the tuber calcanei, a close relationship of both anatomical structures can be visualised using computer-assisted measurements; caution is suggested to prevent sural nerve entrapment in either open or percutaneous Achilles tendon repair.
腓肠神经损伤是微创跟腱修复手术中一个明显的风险。然而，针对腓肠神经在不同层面与跟腱关系的详细解剖学研究较少，甚至在两个平面上的研究都很欠缺。
通过横断面及计算机辅助测定，确定腓肠神经在两个平面上相对于跟腱的位置和走行。
使用计算机辅助方法在两个平面（横断面/矢状面）上，对10具尸体（年龄55.3岁，19 - 89岁）的腓肠神经确切走行进行测定。
腓肠神经在距跟骨结节近端11（8.7 - 12.4）cm处跨过跟腱。外侧交叉点与近端肌肉肌腱交界处之间的距离为35（20 - 58）mm。从跟骨结节开始，在距跟骨结节近端11 cm处，距离为2/2 mm（横断面/矢状面），近端10 cm处为4/4 mm，9 cm处为5/6 mm，5 cm处为8/10 mm，在跟骨结节处为11/18 mm。
在距跟骨结节近端9 - 12 cm处腓肠神经与跟腱外侧近端的交叉区域，使用计算机辅助测量可显示这两个解剖结构的密切关系；建议在开放性或经皮跟腱修复术中小心操作，以防止腓肠神经受压。
