Center for Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital, Kerpener Str. 62, 50937, Cologne, Germany.
Department of Anatomy II, Medical Faculty, University of Cologne, Cologne, Germany.
Arch Orthop Trauma Surg. 2019 Jul;139(7):921-926. doi: 10.1007/s00402-019-03141-7. Epub 2019 Feb 8.
Injuries to the peroneal nerve are a common complication in operative treatment of proximal tibial or fibular fractures. To minimize the risk of iatrogenic injury to the nerve, detailed knowledge of the anatomy of the peroneal nerve is essential. Aim of this study was to present a detailed description of the position and branching of the peroneal nerve based on 3D-images to assist preparation for surgical approaches to the fibular head and the tibial plateau.
The common peroneal nerve, the deep and the superficial peroneal nerve were marked with a radiopaque thread in 18 formalin-embalmed specimens. Three-dimensional X-ray scans were then acquired from the knee and the proximal lower leg in full extension of the knee. In 3D-reconstructions of these scans, distances of the common peroneal nerve and its branches to clearly defined osseous landmarks were measured digitally. Furthermore, the height of the branching of the common peroneal nerve was measured in relation to the landmarks.
The mean distance of the common peroneal nerve at the level of the tibial plateau to its posterior osseous limitation was 7.92 ± 2.42 mm, and 1.31 ± 2.63 mm to the lateral osseous limitation of the tibia. In a transversal plane, distance of the common peroneal nerve branching was 27.56 ± 3.98 mm relative to the level of the most proximal osseous extension of fibula and 11.77 ± 6.1 mm relative to the proximal extension of the tibial tuberosity. The deep peroneal nerve crossed the midline of the fibular shaft at a distance of 22.14 mm ± 4.35 distally to the most proximal extension of the fibula, the superficial peroneal nerve at a distance of 33.56 mm ± 6.68.
As the course of the peroneal nerve is highly variable in between individuals, surgical dissection for operative treatment of proximal posterolateral tibial or fibular fractures has to be done carefully. We defined an area were the peroneal nerve and its branches are unlikely to be found. However, specific safe zones should not be utilized due to the individual anatomic variation.
在胫骨或腓骨近端骨折的手术治疗中，腓总神经损伤是一种常见的并发症。为了最大限度地降低神经医源性损伤的风险，详细了解腓总神经的解剖结构至关重要。本研究的目的是基于 3D 图像详细描述腓总神经的位置和分支，以协助准备腓骨头和胫骨平台的手术入路。
在 18 个福尔马林固定标本中用不透射线的缝线标记腓总神经、腓深神经和腓浅神经。然后从膝关节和小腿近端在膝关节完全伸展的情况下获取三维 X 射线扫描。在这些扫描的 3D 重建中，腓总神经及其分支到明确的骨性标志的距离被数字测量。此外，还测量了腓总神经分支的高度与这些标志的关系。
在胫骨平台水平，腓总神经到其后骨性限制的平均距离为 7.92±2.42mm，到胫骨外侧骨性限制的距离为 1.31±2.63mm。在横断面上，腓总神经分支的距离相对于腓骨最近端骨性延伸的水平为 27.56±3.98mm，相对于胫骨结节近端延伸的距离为 11.77±6.1mm。腓深神经在腓骨干远端距腓骨最近端延伸 22.14mm±4.35mm 处穿过腓骨轴的中线，腓浅神经在距离腓骨最近端延伸 33.56mm±6.68mm 处穿过。
由于腓总神经在个体之间的走行高度多变，因此对胫骨或腓骨近端后外侧骨折进行手术治疗时，需要仔细进行神经解剖。我们定义了一个区域，腓总神经及其分支不太可能在这个区域被发现。然而，由于个体解剖变异，不应利用特定的安全区域。
