Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, OR 97239, USA.
J Orthop Trauma. 2010 Aug;24(8):495-8. doi: 10.1097/BOT.0b013e3181cb584f.
To assess the risk of injury to the superficial peroneal nerve, saphenous nerve, and saphenous vein in percutaneous fixation of the distal fibula and tibia.
Ten adult cadaver lower extremities were instrumented with precontoured periarticular plates for the distal tibia and fibula. Plates were inserted percutaneously along the medial distal tibia and lateral fibula. Smooth wires were inserted percutaneously into each screw hole. Dissection of the superficial peroneal nerve, saphenous nerve, and saphenous vein was performed along their respective course. The position of the neurovascular structures relative to the smooth wires was recorded.
The saphenous nerve and vein had a predictable course along the medial aspect of the ankle. Both structures were injured in every specimen. This occurred consistently at 2.0 to 4.7 cm from the tip of the medial malleolus. The superficial peroneal nerve demonstrated large variance in the exit point from the lateral compartment crural fascia, exiting at an average of 11.6 cm from the tip of the lateral malleolus. Injury occurred in a single specimen at 11.5 cm from this point.
The superficial peroneal nerve, saphenous nerve, and saphenous vein are at risk during percutaneous submuscular plating of the distal fibula and tibia. Careful dissection proximally for the fibula and distally for the tibia can minimize the risk of damage to these structures.
评估经皮固定腓骨远端和胫骨时，腓浅神经、隐神经和隐静脉损伤的风险。
10 具成人尸体下肢进行了关节周围预弯钢板的腓骨远端和胫骨的器械置入。钢板经皮插入胫骨内侧远端和腓骨外侧。将光滑的金属丝经皮插入每个螺钉孔中。沿各自的走行进行腓浅神经、隐神经和隐静脉的解剖。记录神经血管结构相对于光滑金属丝的位置。
隐神经和隐静脉在踝关节内侧有可预测的走行。在每个标本中，这两个结构都受到了损伤。这始终发生在距内踝尖端 2.0 至 4.7 厘米处。腓浅神经从小腿外侧筋膜腔的出口处有很大的变化，从外踝尖端平均距离为 11.6 厘米。在这个点的 11.5 厘米处，有一个标本发生了损伤。
在经皮皮下腓骨和胫骨远端肌内固定时，腓浅神经、隐神经和隐静脉存在风险。腓骨近端和胫骨远端仔细解剖可以最大程度地降低这些结构损伤的风险。
