Johnson Kenneth S, Rowe Joanna, Hans Kanwalgeet, Gordon Victoria, Lewis Adam L, Marolt Clayton, Willett Gilbert M, Orth Charles, Keim-Janssen Sarah, Olinger Anthony
Kansas City University, Kansas City, Missouri, USA.
Creighton University School of Dentistry, Omaha, Nebraska, USA.
Orthop J Sports Med. 2022 Mar 24;10(3):23259671221085272. doi: 10.1177/23259671221085272. eCollection 2022 Mar.
An iatrogenic injury to the infrapatellar branch of the saphenous nerve (IPBSN) is a common precipitant of postoperative knee pain and hypoesthesia.
To locate potential safe zones for incision by observing the patterns and pathway of the IPBSN while examining the relationship of its location to sex, laterality, and leg length.
Descriptive laboratory study.
A total of 107 extended knees from 55 formalin-embalmed cadaveric specimens were dissected. The nerve was measured from palpable landmarks: the patella at the medial (point A) and lateral (point B) borders of the patellar ligament, the medial border of the patellar ligament at the patellar apex (point C) and tibial plateau (point D), the medial epicondyle (point E), and the anterior border of the medial collateral ligament at the tibial plateau (point F). The safe zone was defined as 2 SDs from the mean.
Findings indicated significant correlations between leg length and height ( = 0.832; < .001) as well as between leg length and vertical measurements (≥45°) from points A and B to the IPBSN ( range, 0.193-0.285; range, .004-.049). Male specimens had a more inferior maximum distance from point A to the intersection of the IPBSN and the medial border of the patellar ligament compared with female specimens (6.17 vs 5.28 cm, respectively; = .049). Right knees had a more posterior IPBSN from point F compared with left knees (-0.98 vs-0.02 cm, respectively; = .048). The majority of knees (62.6%; n = 67) had a nerve emerging that penetrated the sartorius muscle. Additionally, 32.7% (n = 35) had redundant innervation, and 25.2% (n = 27) had contribution from the intermediate femoral cutaneous nerve (IFCN).
We identified no safe zone. Significant innervation redundancy with a substantial contribution to the infrapatellar area from the IFCN was noted and contributed to the expansion of the danger zone.
The location of incision and placement of arthroscopic ports might not be as crucial in postoperative pain management as an appreciation of the variance in infrapatellar innervation. The IFCN is a common contributor. Its damage could explain pain refractory to SN blocks and therefore influence anesthetic and analgesic decisions.
隐神经髌下支（IPBSN）的医源性损伤是术后膝关节疼痛和感觉减退的常见诱因。
通过观察IPBSN的走行模式和路径，同时研究其位置与性别、侧别和腿长的关系，来确定潜在的安全切口区域。
描述性实验室研究。
对55个用福尔马林固定的尸体标本的107个伸直膝关节进行解剖。从可触及的标志点测量神经：髌韧带内侧（A点）和外侧（B点）边缘的髌骨、髌骨尖（C点）和胫骨平台（D点）处髌韧带的内侧边缘、内上髁（E点）以及胫骨平台处内侧副韧带的前缘（F点）。安全区域定义为距平均值2个标准差的范围。
结果表明腿长与身高之间存在显著相关性（r = 0.832；P <.001），以及腿长与从A点和B点到IPBSN的垂直测量值（≥45°）之间存在显著相关性（r范围为0.193 - 0.285；P范围为.004 -.049）。与女性标本相比，男性标本从A点到IPBSN与髌韧带内侧边缘交点的最大距离更低（分别为6.17 cm和5.28 cm；P =.049）。与左膝相比，右膝从F点起IPBSN位置更靠后（分别为 - 0.98 cm和 - 0.02 cm；P =.048）。大多数膝关节（62.6%；n = 67）有神经穿出并穿透缝匠肌。此外，32.7%（n = 35）有神经支配冗余，25.2%（n = 27）有股中间皮神经（IFCN）的分支。
我们未发现安全区域。注意到存在显著的神经支配冗余，且IFCN对髌下区域有大量分支，这导致了危险区域的扩大。
在术后疼痛管理中，切口位置和关节镜入路的放置可能不如了解髌下神经支配的差异那么关键。IFCN是常见的分支来源。其损伤可能解释对隐神经阻滞难治的疼痛，因此会影响麻醉和镇痛决策。
