Lui T H, Mak C Y D
Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
Foot Ankle Surg. 2018 Jun;24(3):242-245. doi: 10.1016/j.fas.2017.02.012. Epub 2017 Mar 8.
This research studied the safety and efficacy of a new portal to the spring ligament. This portal is located just plantar to the insertion of the posterior tibial tendon and above the fibrous septum between the posterior tibial and the flexor digitorum longus tendons.
Twelve fresh frozen foot and ankle specimens were used. The distance between the accessory medial portal and the medial plantar nerve was measured. The relation between the medial plantar nerve and the spring ligament was studied. The depth that can be reached through the portal was also assessed.
The average distance between the insertion point of the 3mm diameter metal rod and the medial plantar nerve was 20(6-27)mm. The medial plantar nerve located at lateral third of the ligament in 8 specimens (67%), middle third in 2 specimens (17%) and medial third in 2 specimens (17%). The tip of rod can reach Zone A in all specimens.
This study demonstrated that arthroscopic approach and repair of the spring ligament can injure the medial plantar nerve.
The clinical relevance of this cadaver study is that it confirmed the feasibility of arthroscopic approach to the whole span of the spring ligament and alerted the potential risk of injury to the medial plantar nerve during arthroscopic assisted repair of the ligament.
本研究探讨了一种通向弹簧韧带的新入路的安全性和有效性。该入路位于胫后肌腱止点的足底侧，以及胫后肌腱与趾长屈肌腱之间纤维间隔的上方。
使用12个新鲜冷冻的足踝标本。测量辅助内侧入路与足底内侧神经之间的距离。研究足底内侧神经与弹簧韧带之间的关系。还评估了通过该入路可到达的深度。
直径3mm金属棒插入点与足底内侧神经之间的平均距离为20（6 - 27）mm。8个标本（67%）中足底内侧神经位于韧带的外侧三分之一处，2个标本（17%）位于中间三分之一处，2个标本（17%）位于内侧三分之一处。在所有标本中，金属棒尖端均可到达A区。
本研究表明，关节镜下弹簧韧带入路及修复可能会损伤足底内侧神经。
该尸体研究的临床意义在于，它证实了关节镜下对整个弹簧韧带进行入路的可行性，并提醒在关节镜辅助下修复韧带时存在损伤足底内侧神经的潜在风险。
