Department of Orthopaedic Surgery, Affiliated Hospital of the School of Medicine of Ningbo University, No. 247, Renming Road, Jiangbei District, Ningbo, Zhejiang, China.
Department of Anatomy, Medical School of Ningbo University, Ningbo, Zhejiang, China.
Sci Rep. 2017 Oct 27;7(1):14202. doi: 10.1038/s41598-017-13742-0.
The transfer of the flexor hallucis longus tendon or flexor digitorum longus tendon is frequently used for the treatment of posterior tibial tendon insufficiency or chronic Achilles tendinopathy. According to several anatomical studies, harvesting the flexor hallucis longus (FHL) tendon may cause nerve injury. Sixty-eight embalmed feet were dissected and anatomically classified to define the relationship between Henry's knot and the plantar nerves. Two different configurations were identified. In Pattern 1, which was observed in 64 specimens (94.1%), the distance between the medial plantar nerve and Henry's knot was 5.96 mm (range, 3.34 to 7.84, SD = 1.12). In Pattern 2, which was observed in 4 specimens (5.9%), there was no distance between the medial plantar nerve (MPN) and Henry's knot. No statistically significant difference was observed according to gender or side (p > 0.05). A retraction was performed to harvest the FHL through the posteromedial hindfoot incision using a single minimally invasive technique, and the medial and lateral plantar nerve lesions were scrupulously assessed. In conclusion, medial and lateral plantar nerve injuries did not occur more frequently, even after performing a single minimally invasive incision to harvest the FHL tendon, due to the large distance between the FHL tendon and the medial and lateral plantar nerves.
为治疗胫骨后肌腱功能不全或慢性跟腱病，常采用踇长屈肌腱或趾长屈肌腱转位术。多项解剖学研究表明，踇长屈肌腱（FHL）的采集可能会导致神经损伤。本研究共解剖 68 例防腐足，对跖骨间神经与 Henry 结的关系进行解剖学分类，以明确其解剖结构。研究共发现两种不同的构型。在 64 例（94.1%）标本中观察到构型 1，其跖内侧神经与 Henry 结之间的距离为 5.96mm（范围 3.34-7.84，SD=1.12）。在 4 例（5.9%）标本中观察到构型 2，其跖内侧神经与 Henry 结之间无距离。根据性别或侧别，两种构型的差异均无统计学意义（p>0.05）。通过后内侧足跟切口，采用单一微创技术进行 FHL 肌腱的回缩采集，同时对跖内侧和跖外侧神经损伤进行了仔细评估。综上，由于 FHL 肌腱与跖内侧和跖外侧神经之间存在较大距离，因此，即使采用单一微创切口采集 FHL 肌腱，也不会更频繁地发生内侧和外侧跖骨间神经损伤。
