Kim Hak Jun, Oh Jong-Keon, Oh Chang-Wug, Hwang Jin-Ho, Biswal Sandeep
Department of Orthopedic Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea.
J Trauma. 2010 Feb;68(2):421-4. doi: 10.1097/TA.0b013e3181a70847.
Because of the anatomic variations of the superficial peroneal nerve (SPN), it has long been stressed that caution should be exercised at the time of open reduction and internal fixation (ORIF) of the lateral malleolus.
Blair and Botte described type B intermediate dorsal cutaneous nerve (IDCN) in which the SPN penetrates crural fascia posterior to the fibula about 5 cm proximal to the joint and crosses the lateral border of the fibulae. We hypothesized that the type B IDCN is especially vulnerable to direct surgical injury if present and the anterior transposition of this nerve may decrease the incidence of symptoms related to the SPN injury. Fifty-three ankle fractures in 53 adult patients treated by the ORIF of lateral malleolus using the lateral approach between the periods from May 2001 to December 2006 were included. Intraoperative documentation about the presence of the type B IDCN variant at the surgical field was performed, and preoperative and postoperative sensory changes were carefully evaluated.
We encountered Blair type B variant in 7 cases (12%). The IDCN was carefully dissected and transposed anteriorly before the plating. One of these seven patients had sensory deficit preoperatively, and it was recovered spontaneously 5 months after operation. There was one patient whose IDCN was inadvertently severed, and it was repaired. At the time of last follow-up, only partial recovery of the sensory deficit was noted. Five of seven patients did not show any neurologic deficit with anterior transposition.
Recognition and anterior transposition of the type B IDCN could reduce the incidence of the SPN nerve injuries during the ORIF of the lateral malleolar fractures.
由于腓浅神经（SPN）存在解剖变异，长期以来一直强调在外踝切开复位内固定（ORIF）时应谨慎操作。
布莱尔和博特描述了B型中间背侧皮神经（IDCN），其中SPN在关节近端约5 cm处穿过腓骨后方的小腿筋膜，并越过腓骨的外侧缘。我们假设，如果存在B型IDCN，其特别容易受到直接手术损伤，并且该神经的前移可能会降低与SPN损伤相关症状的发生率。纳入了2001年5月至2006年12月期间采用外侧入路对外踝进行ORIF治疗的53例成年患者的53例踝关节骨折。术中记录手术区域是否存在B型IDCN变异，并仔细评估术前和术后的感觉变化。
我们在7例（12%）患者中遇到了布莱尔B型变异。在钢板固定前，仔细解剖并将IDCN向前移位。这7例患者中有1例术前存在感觉障碍，术后5个月自发恢复。有1例患者的IDCN被无意中切断并进行了修复。在最后一次随访时，仅发现感觉障碍部分恢复。7例患者中有5例在神经前移后未出现任何神经功能缺损。
识别并前移B型IDCN可降低外踝骨折ORIF期间SPN神经损伤的发生率。
