Popieluszko Patrick, Mizia Ewa, Henry Brandon Michael, PĘkala PrzemysŁaw A, Sanna Beatrice, Roy Joyeeta, Loukas Marios, Tomaszewski Krzysztof A
International Evidence-Based Anatomy Working Group, Krakow, Poland.
Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
Clin Anat. 2018 May;31(4):450-455. doi: 10.1002/ca.22997. Epub 2017 Nov 11.
The aim of this study was (a) to examine the anatomy of the sural nerve (SN) in a sample of 30 patients and (b) to analyze the incidence of different origins of the SN, and the distance of the SN from planned arthroscopic portals. An ultrasound (USG) examination of the SN was performed bilaterally on thirty healthy patients with no history of surgery or trauma of the lower limb. The SNs were classified into six main types of pattern, with an additional category for new and unclassified types. Each of Types 1 and 3 had two subdivisions. The distances from the superior border of the calcaneal tuberosity to the three simulated arthroscopy portal sites (Z1, Z1.5, Z2) to the SN were measured. A total of 30 patients (n = 60 limbs) with an average age of 27 ± 7.5 years were examined and the SN was visualized in all cases. The most common origin was Type 3A, accounting for 30% of limbs. Type 2 was the second most common seen in 18.3%. The distances of the SN from arthroscopic portal placement sites above the lateral malleolus were 2.07 ± 0.39 cm at the Z1 portal, 2.15 ± 0.38 cm at Z1.5, and 2.28 ± 0.33 cm at Z2. The variability in the anatomy of the SN warrants the use of USG to locate it accurately, thus preventing iatrogenic injury when portals are placed for arthroscopy, improving proper administration of anesthesia, and helping to localize the nerve for graft harvesting. Clin. Anat. 31:450-455, 2018. © 2017 Wiley Periodicals, Inc.
（a）在30例患者样本中检查腓肠神经（SN）的解剖结构；（b）分析SN不同起源的发生率，以及SN与计划关节镜入路的距离。对30例无下肢手术或创伤史的健康患者双侧进行SN的超声（USG）检查。SN被分为六种主要类型模式，另有一类用于新的和未分类的类型。类型1和类型3各有两个亚类。测量从跟骨结节上缘到三个模拟关节镜入路部位（Z1、Z1.5、Z2）至SN的距离。共检查了30例患者（n = 60条肢体），平均年龄27±7.5岁，所有病例均能看到SN。最常见的起源是3A型，占肢体的30%。类型2是第二常见的，占18.3%。在踝关节外侧上方，SN与关节镜入路部位的距离在Z1入路处为2.07±0.39 cm，在Z1.5处为2.15±0.38 cm，在Z2处为2.28±0.33 cm。SN解剖结构的变异性表明需要使用USG准确定位它，从而在进行关节镜入路时防止医源性损伤，改善麻醉的正确实施，并有助于定位神经以获取移植物。临床解剖学。31:450 - 455, 2018。© 2017威利期刊公司。
