Department of Cellular and Molecular Medicine, The Panum Institute, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen N, Denmark.
Section for Sports Traumatology M51, Bispebjerg-Frederiksberg Hospital, A Part of IOC Research Center Copenhagen, Nielsine Nielsens Vej 3, 2400, Copenhagen NV, Denmark.
Knee Surg Sports Traumatol Arthrosc. 2020 Mar;28(3):969-974. doi: 10.1007/s00167-019-05605-0. Epub 2019 Jul 3.
The purpose of this study was to map saphenous nerve injuries after gracilis tendon harvest, with the aim of contributing knowledge that makes it possible to prevent these injuries.
Twenty-two cadaver limbs were used. Three were dissected to examine fascial structures between the saphenous nerve and the gracilis tendon. In 19 limbs, the gracilis tendon was harvested according to standard operative routine. The saphenous nerve was subsequently exposed by dissection and injuries were recorded.
A well-defined sub-sartorial fascial layer separated the saphenous nerve from the gracilis tendon. Incisional injuries involving either a medial cutaneous crural branch or the infrapatellar branch were found in 14 of the 19 cases. Non-incisional injuries affecting the sartorial branch of the saphenous nerve (to conform to most surgical literature, we use the term 'sartorial branch' to denote the continuation of the saphenous nerve after departure of the infrapatellar branch) were found in six cases located 5-8 cm proximal and posterior to the gracilis tendon insertion on tibia. The fascia separating the saphenous nerve from the gracilis tendon had been perforated in relation to all non-incisional injuries.
Small subcutaneous branches of the saphenous nerve are at risk of injury from the incision, while the sartorial branch is at risk outside the incision area. Descriptions of the location of non-incisional injuries have not been published before and are of clinical relevance, as they can contribute to the prevention of saphenous nerve injuries during gracilis tendon harvest.
本研究旨在绘制隐神经损伤后的解剖位置图，以期提供相关知识以预防此类损伤。
共使用 22 具尸体标本。其中 3 具用于检查隐神经与股薄肌腱之间的筋膜结构。19 具标本按标准手术常规进行股薄肌腱采集。随后解剖暴露隐神经并记录损伤情况。
在 19 例中，发现有明确的亚下筋膜层将隐神经与股薄肌腱分开。14 例存在切口损伤，包括皮支或髌下支。6 例存在非切口损伤，影响隐神经的收肌支（为与大多数外科文献一致，我们使用术语“收肌支”表示隐神经离开髌下支后的延续），位于股薄肌腱胫骨止点近端和后方 5-8cm 处。所有非切口损伤均与将隐神经与股薄肌腱分开的筋膜穿孔有关。
隐神经的小皮支在切口处有受伤风险，而收肌支在切口区域外有受伤风险。非切口损伤的位置描述以前未曾发表，具有临床意义，因为它们有助于预防股薄肌腱采集过程中隐神经损伤。
