Orduña Valls Jorge M, Vallejo Ricardo, López Pais Pablo, Soto Eliezer, Torres Rodríguez Daniel, Cedeño David L, Tornero Tornero Carlos, Quintáns Rodríguez Maximino, Baluja González Aurora, Álvarez Escudero Julián
From the *Departamento de Anestesióloga, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; †Departamento de Anestesióloga, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Valencia, Valencia, Spain; ‡Clínica Indolor, Valencia, Spain; and §Millennium Pain Center, Bloomington, IL.
Reg Anesth Pain Med. 2017 Jan/Feb;42(1):90-98. doi: 10.1097/AAP.0000000000000516.
Osteoarthrosis is a main cause of knee pain in the elderly. Pain associated with this condition is often refractory to conservative treatment. Total knee replacement may be the best option for severe pathologies; however, the occurrence of a chronic pain state after knee replacement has been well documented in the literature. The previous descriptions of the genicular nerves have been considered somewhat inaccurate. This innervation is complex and exhibits significant interindividual variability. A precise description of these nerves will increase our knowledge on different patterns and targets, to guide treatment and improve outcomes. The objective of this study was to determine sensory innervation patterns of the knee joint and correlate them with dynamic visualization via ultrasound imaging.
Systematic cadaveric dissections were performed to determine different patterns of sensory innervation of the knee followed by ultrasonographic correlation. A short-axis ultrasound view of the nerves was used to inject India ink at several points along their course to facilitate the anatomic dissection and confirm their location among adjacent structures.
The visualized structures were the following: infrapatellar branch of the saphenous nerve, the branches to vastus medialis, intermedius, and lateralis muscles; obturator nerve; and lateral retinacular and recurrent peroneal nerves.
We conclude that reproducible correlations showing the sensory innervations for the knee are linked to muscular structures. However, high variability among individuals makes it difficult to predict their paths. Our systematic approach, using direct visualization via ultrasound, allows a more accurate placement of the needle for therapeutic purposes.
骨关节炎是老年人膝关节疼痛的主要原因。与这种情况相关的疼痛通常对保守治疗无效。全膝关节置换术可能是严重病变的最佳选择；然而，膝关节置换术后慢性疼痛状态的发生在文献中已有充分记载。以往对膝神经的描述被认为有些不准确。这种神经支配是复杂的，并且个体间存在显著差异。对这些神经的精确描述将增加我们对不同模式和靶点的了解，以指导治疗并改善治疗效果。本研究的目的是确定膝关节的感觉神经支配模式，并通过超声成像将其与动态可视化相关联。
进行系统的尸体解剖以确定膝关节感觉神经支配的不同模式，随后进行超声相关性研究。使用神经的短轴超声视图在其走行的几个点注入印度墨水，以方便解剖并确认它们在相邻结构中的位置。
可视化的结构如下：隐神经髌下支、股内侧肌、股中间肌和股外侧肌的分支；闭孔神经；以及外侧支持带和腓总返神经。
我们得出结论，显示膝关节感觉神经支配的可重复相关性与肌肉结构相关。然而，个体间的高度变异性使得难以预测它们的走行。我们使用超声直接可视化的系统方法允许更准确地放置针以用于治疗目的。
