Mizia Ewa, Pękala Przemysław A, Chomicki-Bindas Piotr, Marchewka Wojciech, Loukas Marios, Zayachkowski Alexander G, Tomaszewski Krzysztof A
Department of Anatomy, Jagiellonian University Medical College, Poland.
International Evidence-Based Anatomy Working Group, Krakow, Poland.
Clin Anat. 2018 Sep;31(6):870-877. doi: 10.1002/ca.23205. Epub 2018 Oct 18.
When surgeons operate on the foot and ankle, the most common complication that may arise is injury of the cutaneous nerves. The sural nerve (SN) is potentially at risk of being injured when treating fractures involving the distal tibia using the posterolateral approach. The aim of this study was to evaluate how differences in length and position of the surgical treatment of fractures involving the distal tibia can affect the risk of SN injury. The study involved 40 healthy volunteers (n = 80 lower limbs). Ultrasound simulation of each potential surgical incision site was used to locate the SN and to assess the risk of injury. The study showed that the SN predominantly travels more posteriorly at levels more proximal from the tip of the lateral malleolus. At these more proximal points of the SN's course, it was proven that there was an overall increased incidence of iatrogenic injury to the SN in incisions made closer to the Achilles tendon. Based on these results, a quasi 3 dimensional figure was created showing the anatomical structures of this region to identify areas at high risk for SN injury. By revealing how length and position of the surgical incision can influence the risk of SN injury, we hope to provide information to surgeons on the optimal technique to avoid iatrogenic SN injury while operating on the distal tibia via a posterolateral approach. Clin. Anat. 31:870-877, 2018. © 2018 Wiley Periodicals, Inc.
当外科医生对足踝进行手术时，可能出现的最常见并发症是皮神经损伤。在采用后外侧入路治疗涉及胫骨远端的骨折时，腓肠神经（SN）有受到损伤的潜在风险。本研究的目的是评估涉及胫骨远端骨折手术治疗的长度和位置差异如何影响SN损伤风险。该研究纳入了40名健康志愿者（n = 80条下肢）。通过对每个潜在手术切口部位进行超声模拟来定位SN并评估损伤风险。研究表明，SN在距外踝尖更近端的水平主要走行于更靠后的位置。在SN走行的这些更近端点，已证实靠近跟腱处的切口导致SN医源性损伤的总体发生率增加。基于这些结果，创建了一个准三维图形，展示该区域的解剖结构，以识别SN损伤的高风险区域。通过揭示手术切口的长度和位置如何影响SN损伤风险，我们希望为外科医生提供信息，以便他们在通过后外侧入路对胫骨远端进行手术时采用最佳技术避免医源性SN损伤。《临床解剖学》31:870 - 877，2018年。© 2018威利期刊公司
