Krijgh David D, List Emile B, Teunis Teun, Bleys Ronald L A W, Coert J Henk
Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, The Netherlands.
Department of Orthopaedic Surgery, University Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
JPRAS Open. 2022 Sep 5;34:144-151. doi: 10.1016/j.jpra.2022.08.006. eCollection 2022 Dec.
Nerve injury of the saphenous nerve or infrapatellar branch seems to be a frequent complication following knee surgery or trauma. Denervation results vary, and in some cases, no pain relief is achieved. This might be due to anatomic variation. The purpose of this anatomical study is to identify the variation in the course of the infrapatellar branch and saphenous nerve. We dissected 18 cadavers from adult donors. Medial to the knee, the saphenous nerve and infrapatellar branch were identified and followed proximally to the point where the infrapatellar branch branched from the saphenous nerve. The location where the infrapatellar branch came off from the saphenous nerve relative to the knee joint and where it passed the knee joint were measured. A total of 23 infrapatellar branches were found. We identified 10 branches between 0-10 cm proximal to the knee joint, 3 branches at 10-20 cm, and 9 branches at >20 cm. Between the patella and semitendinosus tendon, the knee joint was crossed by 5 branches in the anterior, 15 in the middle, and 2 in the posterior one-third. The origin of the infrapatellar branch and the location at which it passes the knee are highly variable. This, in addition to people having multiple branches, might explain why denervation is frequently unsuccessful. Based on the anatomical findings, we propose a more proximal diagnostic nerve block to help differentiate between a distal-middle or proximal origin of the infrapatellar branch. Appropriate placement of the nerve block might help identify people who benefit from denervation.
隐神经或髌下支的神经损伤似乎是膝关节手术或创伤后常见的并发症。去神经支配的结果各不相同，在某些情况下，无法实现疼痛缓解。这可能是由于解剖变异。本解剖学研究的目的是确定髌下支和隐神经走行的变异情况。我们解剖了18具成年捐赠者的尸体。在膝关节内侧，识别出隐神经和髌下支，并向近端追踪至髌下支从隐神经分出的点。测量髌下支从隐神经分出相对于膝关节的位置以及它经过膝关节的位置。共发现23条髌下支。我们在膝关节近端0 - 10厘米处识别出10条分支，10 - 20厘米处有3条分支，超过20厘米处有9条分支。在髌骨和半腱肌腱之间，膝关节前1/3有5条分支穿过，中1/3有15条，后1/3有2条。髌下支的起源及其经过膝关节的位置高度可变。此外，人们存在多条分支，这可能解释了为什么去神经支配常常不成功。基于解剖学发现，我们提出一种更靠近近端的诊断性神经阻滞，以帮助区分髌下支的远 - 中或近端起源。神经阻滞的恰当定位可能有助于识别能从去神经支配中获益的人群。
