Sanders Brett, Rolf Robert, McClelland Walter, Xerogeanes John
Center for Orthopaedics and Sports Medicine, Chattanooga, Tennessee, USA.
Arthroscopy. 2007 Sep;23(9):956-63. doi: 10.1016/j.arthro.2007.03.099.
Injury to the sartorial (terminal) branch of the saphenous nerve (SBSN) has received little attention in the literature, despite its anatomic proximity to the hamstring tendons during autogenous harvesting. This study aims to define the prevalence of saphenous nerve injury after anterior cruciate ligament (ACL) reconstruction with autogenous hamstrings and define clinically relevant anatomy that may contribute to nerve injury.
Surveys regarding the presence and duration of sensory changes in the infrapatellar branch of the saphenous nerve (IPBSN) and SBSN were retrospectively sent to 164 patients who had undergone arthroscopically assisted ACL reconstruction with hamstring autograft over a 4-year period. Eleven cadavers were then dissected to identify the relation of the saphenous nerve to the hamstring tendons and accessory insertions.
Postoperative sensory disturbance was present in 74% of patients surveyed. Concomitant injuries to both the SBSN and IPBSN occurred in 32% of patients, whereas isolated paresthesias in the SBSN and IPBSN distribution affected 23% and 19%, respectively. The saphenous nerve was intimately associated with the gracilis for 4.6 cm in the distal thigh, from 7.2 cm (range, 6.4 to 9.3 cm) to 11.8 cm (range, 7 to 13.2 cm) proximal to its insertion. Accessory hamstring insertions were present distal to the point where the sartorial branch became extrafascial.
The SBSN is at higher risk of injury during hamstring ACL reconstruction than has been previously reported. The saphenous nerve is intimately involved with the gracilis tendon for a portion of its course in the distal thigh, likely predisposing it to damage during passage of the tendon stripper.
Level IV.
隐神经的缝匠肌（终末）支（SBSN）损伤在文献中很少受到关注，尽管在自体取材时它在解剖位置上与腘绳肌腱相邻。本研究旨在确定自体腘绳肌腱重建前交叉韧带（ACL）后隐神经损伤的发生率，并确定可能导致神经损伤的临床相关解剖结构。
回顾性地向164例在4年期间接受关节镜辅助下自体腘绳肌腱重建ACL的患者发送了关于隐神经髌下支（IPBSN）和SBSN感觉变化的存在情况及持续时间的调查问卷。然后解剖11具尸体，以确定隐神经与腘绳肌腱及附属止点的关系。
在接受调查的患者中，74%出现了术后感觉障碍。32%的患者同时出现了SBSN和IPBSN损伤，而SBSN和IPBSN分布区域的孤立性感觉异常分别影响了23%和19%的患者。在大腿远端，隐神经与股薄肌紧密相连4.6 cm，从其止点近端7.2 cm（范围6.4至9.3 cm）至11.8 cm（范围7至13.2 cm）。在缝匠肌支穿出深筋膜的点远端存在腘绳肌附属止点。
在腘绳肌腱重建ACL过程中，SBSN的损伤风险比先前报道的更高。隐神经在大腿远端的一段行程中与股薄肌腱紧密相连，这可能使其在肌腱剥离器通过时易受损伤。
IV级。
