Hospices Civils de Lyon, Hôpital Lyon Sud, Chirurgie Orthopédique et Traumatologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France.
Univ de Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMRT_9406, Lyon, France.
Surg Radiol Anat. 2022 Apr;44(4):609-615. doi: 10.1007/s00276-022-02909-8. Epub 2022 Mar 3.
Superficial fibular nerve (SFN) and sural nerve are at risk during osteosynthesis of the lateral malleolus. The aim of this anatomical study was to describe the relationships of the superficial fibular and sural nerves with respect to the lateral malleolus.
Nine corpses (18 ankles) were dissected, using a direct lateral approach. Measurements were recorded between the fibula and the nerves, and the pattern variations of the SFN were recorded for both right and left side to assess intra-individual variability.
Distance between the tip of the lateral malleolus and the piercing of fascia cruris was 111 ± 26 mm for type 1 pattern, and range was 46-161 mm all types included. 78% (14 SFN) were type 1 pattern, 17% (3 SFN) were type 2 pattern, and 5% (1 SFN) were type 3 pattern. 44% (4 specimen) had a type 1 pattern SFN on one ankle and another pattern on the other ankle. The sural nerve was always observed just posterior to the lateral malleolus.
This study demonstrated a great inter-individual variability especially for the SFN, but also an intra-individual variability with frequent different patterns between right and left leg. It is important to know the anatomical variations of the SFN and sural nerve to decrease the risk of intra operative nerve injury during direct lateral approach of lateral malleolus.
腓浅神经（SFN）和腓肠神经在外踝骨折固定时存在损伤风险。本解剖学研究旨在描述腓浅神经和腓肠神经与外踝的关系。
采用直接外侧入路对 9 具尸体（18 个踝关节）进行解剖。记录腓骨与神经之间的距离，并记录 SFN 的变异模式，以评估左右两侧的个体内变异性。
外侧踝尖与筋膜穿刺点之间的距离为 111±26mm，所有类型均包括在内，范围为 46-161mm。78%（14 个 SFN）为 1 型模式，17%（3 个 SFN）为 2 型模式，5%（1 个 SFN）为 3 型模式。44%（4 个标本）在一个踝关节上为 1 型模式 SFN，而另一个踝关节上为另一种模式。腓肠神经始终位于外踝后方。
本研究表明 SFN 个体间变异性较大，个体内也存在变异性，左右侧经常存在不同的模式。了解 SFN 和腓肠神经的解剖变异对于降低直接外侧入路治疗外踝骨折时的术中神经损伤风险非常重要。
