Department of Neurosurgery, Stanford University Medical Center, Stanford, California 94305-5327, USA.
Neurosurgery. 2009 Oct;65(4 Suppl):A18-23. doi: 10.1227/01.NEU.0000339123.74649.BE.
With the use of data from 3 Louisiana State University Health Sciences Center (LSUHSC) publications, various parameters for buttock/thigh-level sciatic nerve and tibial and common peroneal divisions/nerve injuries were summarized, and outcomes were compared.
Data from 806 buttock/thigh-level sciatic nerve and tibial and common peroneal division/nerve injury repairs were summarized. Lesion types, repair techniques, and outcomes were compared.
Acute lacerations undergoing suture repair were best for the thigh-then-buttock-level tibial (93%/73%) and then same-level common peroneal divisions (69%/30%); at the knee level, tibial outcomes (100%) were better than those for the common peroneal nerve (CPN) (84%). Secondary graft repairs for lacerations had good outcomes for the thigh-then-buttock-level tibial (80%/62%), followed by common peroneal divisions at the same levels (45%/24%). The knee/leg-level tibial nerve (94%) did better than the CPN (40%) here. In-continuity lesions with positive intraoperative nerve action potentials underwent neurolysis with better results for the thigh-then-buttock-level tibial division (95%/86%) than for same-level CPN (78%/69%). The knee/leg-level tibial nerve did better than the CPN (95%/93%).
Better recovery of buttock- and thigh-level tibial division/nerve occurs because: 1) the CPN is lateral and thus vulnerable to a more severe injury; 2) the tibial nerve is more elastic at impact owing to its singular-fixation site (the CPN has a dual fixation); 3) the tibial nerve has a better blood supply and regeneration; 4) the tibial nerve has a higher force-absorbing fascicle/connective tissue count than the CPN; and 5) the tibial nerve-innervated gastrocnemius soleus requires less reinnervation for functional contraction than deep peroneal branches, which innervate long, thin extensor muscles at multiple sites and require coordinated nerve input for effective contraction.
利用路易斯安那州立大学健康科学中心（LSUHSC）的 3 项出版物的数据，总结了臀股部/大腿坐骨神经和胫神经及腓总神经分支/神经损伤的各种参数，并比较了结果。
总结了 806 例臀股部/大腿坐骨神经和胫神经及腓总神经分支/神经损伤修复的数据。比较了病变类型、修复技术和结果。
急性撕裂伤行缝合修复时，大腿-臀部水平的胫神经（93%/73%）和同水平腓总神经（69%/30%）效果最佳；在膝关节水平，胫神经的结果（100%）优于腓总神经（CPN）（84%）。撕裂伤的二次移植物修复效果较好的是大腿-臀部水平的胫神经（80%/62%），其次是同水平的腓总神经分支（45%/24%）。此处膝关节/小腿水平的胫神经（94%）优于腓总神经（40%）。连续性损伤，术中神经动作电位阳性，行神经松解术，大腿-臀部水平的胫神经分支（95%/86%）效果优于同水平腓总神经（78%/69%）。膝关节/小腿水平的胫神经优于腓总神经（95%/93%）。
臀股部和大腿水平的胫神经/分支恢复较好，原因如下：1）腓总神经位于外侧，因此更容易受到更严重的损伤；2）胫神经在撞击时更具弹性，因为它只有一个固定点（腓总神经有两个固定点）；3）胫神经的血液供应和再生更好；4）胫神经的受力纤维/结缔组织比腓总神经多；5）胫神经支配的比目鱼肌-跟腱需要较少的神经再支配来实现功能性收缩，而腓深神经支配多个部位的长而细的伸肌，需要协调的神经输入才能进行有效的收缩。
