Zappia Marcello, Berritto Daniela, Oliva Francesco, Maffulli Nicola
Dipartimento di Medicina e di Scienze della Salute, Università degli Studi del Molise, Via De Sanctis 1, 86100, Campobasso, Italy.
Department of Radiology, Private Hospital "Villa Dei Fiori" S.r.l. Accredited to National Health System, Acerra (NA), Italy.
Foot Ankle Surg. 2018 Aug;24(4):342-346. doi: 10.1016/j.fas.2017.03.006. Epub 2017 Mar 30.
Percutaneous Achilles tendon repair has been developed to minimise soft tissue complications following treatment of tendon ruptures. However, there are concerns because of the risk of sural nerve injury. Few studies have investigated the relationship between the Achilles tendon, the sural nerve and its several anatomical course variants.
We studied 7 cadaveric limbs (7 Achilles tendons) in which a percutaneous repair of the Achilles tendon was performed. On each tendon, high resolution real time ultrasonography examination was performed by an experienced musculoskeletal radiologist before and after the procedure, with the surgeons blind to the results of the scan both before and after surgery.
In two instances, high resolution real time ultrasonography examination revealed nerve entrapment at the level of most proximal lateral suture.
Since the sural nerve can be easily visualised using high-frequency high resolution real time ultrasonography, intraoperative ultrasound can be of assistance during percutaneous repair of Achilles tendon rupture.
The sural nerve can be readily visualised by high-frequency high resolution real time ultrasonography probes. It could be beneficial to use high resolution real time ultrasonography intraoperatively or perioperatively to minimise the risks of sural nerve injury when undertaking percutaneous repair of Achilles tendon tears.
经皮跟腱修复术已被开发出来，以尽量减少肌腱断裂治疗后的软组织并发症。然而，由于存在腓肠神经损伤的风险，人们对此有所担忧。很少有研究调查跟腱、腓肠神经及其几种解剖走行变异之间的关系。
我们研究了7具尸体下肢（7条跟腱），对其进行了经皮跟腱修复术。在每条肌腱上，由一位经验丰富的肌肉骨骼放射科医生在手术前后进行高分辨率实时超声检查，手术医生在手术前后均对扫描结果不知情。
在两例中，高分辨率实时超声检查显示在最近端外侧缝线水平处有神经卡压。
由于使用高频高分辨率实时超声可以很容易地观察到腓肠神经，术中超声在经皮修复跟腱断裂时可提供帮助。
高频高分辨率实时超声探头可以很容易地观察到腓肠神经。在进行经皮修复跟腱撕裂时，术中或围手术期使用高分辨率实时超声，以尽量减少腓肠神经损伤的风险，可能是有益的。
