Tonogai Ichiro, Hayashi Fumio, Tsuruo Yoshihiro, Sairyo Koichi
Assistant Professor, Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan.
Senior Resident, Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan.
J Foot Ankle Surg. 2018 May-Jun;57(3):537-542. doi: 10.1053/j.jfas.2017.11.029. Epub 2018 Mar 13.
Arthroscopy is an important and minimally invasive diagnostic and therapeutic tool. However, the risk of injury to the neurovascular structures around the portals exists during arthroscopy of the ankle. In the present study, we measured the distance between each portal and the adjacent neurovascular structures with the foot in plantarflexion and dorsiflexion in the Japanese population. Standard anterolateral (AL), anteromedial, posterolateral (PL), and posteromedial portal positions were identified in 6 fresh adult cadaveric feet. The skin was dissected from the underlying tissue to visualize the adjacent neurovascular structures as noninvasively as possible. The superficial peroneal nerve was the structure closest to an anterior (i.e., AL) portal (3.2 ± 4.2 and 8.3 ± 3.9 mm in plantarflexion and 5.2 ± 4.3 and 10.8 ± 4.1 mm in dorsiflexion), followed by the saphenous nerve and great saphenous vein (SpV). The distance from the superficial peroneal nerve to the AL portal and from the saphenous nerve and great SpV to the anteromedial portal increased significantly with dorsiflexion and decreased significantly with plantarflexion. The sural nerve was the structure closest to the posterior (i.e., PL) portal (10.4 ± 4.8 mm in plantarflexion and 8.5 ± 3.9 mm in dorsiflexion), followed by the lesser SpV. The distance from the sural nerve, saphenous nerve, and lesser SpV to the PL portal and from flexor hallucis longus, posterior tibial artery, and tibial nerve to the posteromedial portal increased significantly in plantarflexion and decreased significantly in dorsiflexion. These findings could help to prevent damage to the neurovascular structures during ankle arthroscopy.
关节镜检查是一种重要的微创诊断和治疗工具。然而，在踝关节镜检查过程中，存在损伤入口周围神经血管结构的风险。在本研究中，我们在日本人群中测量了足部处于跖屈和背屈状态时每个入口与相邻神经血管结构之间的距离。在6只新鲜成人尸体足中确定了标准的前外侧（AL）、前内侧、后外侧（PL）和后内侧入口位置。从下方组织中分离皮肤，以尽可能无创地观察相邻的神经血管结构。腓浅神经是最靠近前侧（即AL）入口的结构（跖屈时为3.2±4.2和8.3±3.9毫米，背屈时为5.2±4.3和10.8±4.1毫米），其次是隐神经和大隐静脉（SpV）。从腓浅神经到AL入口以及从隐神经和大隐静脉到前内侧入口的距离在背屈时显著增加，在跖屈时显著减小。腓肠神经是最靠近后侧（即PL）入口的结构（跖屈时为10.4±4.8毫米，背屈时为8.5±3.9毫米），其次是小隐静脉。从腓肠神经、隐神经和小隐静脉到PL入口以及从拇长屈肌、胫后动脉和胫神经到后内侧入口的距离在跖屈时显著增加，在背屈时显著减小。这些发现有助于预防踝关节镜检查期间神经血管结构的损伤。
