Baruah Ranjit Kumar, Harikrishnan S V, Baruah Jishnu Prakash
Department of Orthopaedics, Assam Medical College & Hospital, Dibrugarh, Assam.
J Clin Orthop Trauma. 2019 Mar-Apr;10(2):432-438. doi: 10.1016/j.jcot.2018.05.002. Epub 2018 May 8.
Peroneal nerve impalement is a recognized complication of percutaneous placement of fibular transfixation wires by palpatory method after increase use of ilizarov technique in treatment of Tibial fractures, deformity correction and limb lengthening. The purpose of this study was to identify the relationship between the Common Peroneal Nerve (CPN) and the palpable landmark, fibular head for insertion of proximal fibular transfixation wire, safe zones in proximal tibia and percentage of fibula where nerve crosses the neck.
Standard 1.8-mm Ilizarov k- wires were inserted in the fibula head of fresh 10 un-embalmed cadaveric knees. Wires were inserted percutaneously to the fibula head by palpatory technique. The course of common peroneal nerve was dissected. Distances from wire entry point to the course of the common peroneal nerve were measured post-wire insertion.
The mean distance of the common peroneal nerve from the anterior aspect of the broadest point of the fibular head was 25.10 ± 4.39 mm (range 16-35 mm). Common peroneal nerve was seen to cross the neck of fibula at a mean distance of 32.3 ± 8.53 mm (range 20-50 mm). Wire placement was found to be on average, 46% of the maximal AP diameter of the fibula head and 44% of the distance from tip of fibula to the point of nerve crossing fibula neck.
We recommend Proximal fibula transfixation wires are safer to pass with in 2 cm from the tip of the styloid process of the fibula, Anterior half of the head of fibula, <8% of total fibular length, Ventral half of the anterior compartment to avoid injury to peroneal fan. The palpable landmark of fibula is a misinterpretation; it is just the prominent subcutaneous portion of fibula and not the styloid process of fibula which on dissection was located much posterior. Better to take fluoroscopic guidance in difficult cases where palpation of head of fibula is difficult.
在伊里扎洛夫技术更多地用于治疗胫骨骨折、畸形矫正和肢体延长后，腓总神经穿刺是经皮放置腓骨固定针时一种公认的并发症。本研究的目的是确定腓总神经与可触及标志——用于插入近端腓骨固定针的腓骨头、胫骨近端的安全区域以及神经穿过腓骨颈处腓骨长度的百分比之间的关系。
将标准的1.8毫米伊里扎洛夫克氏针插入10个新鲜未防腐尸体膝关节的腓骨头。通过触诊技术经皮将针插入腓骨头。解剖腓总神经的走行。在插入针后测量从针的进针点到腓总神经走行的距离。
腓总神经距腓骨头最宽点前缘的平均距离为25.10±4.39毫米（范围16 - 35毫米）。可见腓总神经在距腓骨颈平均32.3±8.53毫米（范围20 - 50毫米）处穿过腓骨颈。发现针的放置平均在腓骨头最大前后径的46%处，以及从腓骨尖端到神经穿过腓骨颈点距离的44%处。
我们建议，近端腓骨固定针在距腓骨茎突尖端2厘米范围内、腓骨头的前半部分、腓骨总长度的<8%、前侧间室的腹侧半部分通过更安全，以避免损伤腓总神经丛。腓骨的可触及标志是一种误解；它只是腓骨突出的皮下部分，而不是解剖时位于更后方的腓骨茎突。在难以触及腓骨头的困难病例中，最好采用透视引导。
