超声评估新的表面参照线以描述腓肠神经的位置和后侧腿部入路时需要考虑的安全区域。
Ultrasound evaluation of a new surface reference line to describe sural nerve location and safe zones to consider in posterior leg approaches.
机构信息
Master Fellow Foot and Ankle Surgery, Universitat de Barcelona, Barcelona, Spain.
Department of Orthopedic and Traumatology, Hospital Clínico La Florida / Clínica Las Condes, Santiago, Chile.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2023 Jun;31(6):2216-2225. doi: 10.1007/s00167-022-07294-8. Epub 2022 Dec 26.
PURPOSE
Several authors have described methods to predict the sural nerve pathway with non-proportional numerical distances, but none have proposed a person-proportional, reproducible method with anatomical references. The aim of this research is to describe ultrasonographically the distance and crossing zone between a surface reference line and the position of the sural nerve.
METHODS
Descriptive cross-sectional study, performed between January and April 2022 in patients requiring foot surgery who met inclusion criteria. The sural nerve course in the posterior leg was located and marked using ultrasound. Landmarks were drawn with a straight line from the medial femoral condyle to the tip of the fibula. Four equal zones were established in the leg by subdividing the distal half of the line. This way, areas based on simple anatomical proportions for each patient were studied. The distance between the marking and the ultrasound nerve position was measured in these 4 zones, creating intersection points and safety areas. Location and distances from the sural nerve to the proposed landmarks were assessed.
RESULTS
One-hundred and four lower limbs, 52 left and 52 right, assessed in 52 patients were included. The shortest median distance of the nerve passage was 2.9 mm from Point 2. The sural nerve intersection was 60/104 (57.7%) in Zone B, 21/104 (20.1%) in Zone C and 19/104 (18.3%) in Zone A. Safety zones were established. Average 80.5% of coincidence in sural nerve localization was found in the distal half of the leg, in relation to the surface reference line when comparing both legs of each patient.
CONCLUSIONS
This study proposes a simple, reproducible, non-invasive and, for the first time, person-proportional method, that describes the distance and location of the main areas of intersection of the sural nerve with points and zones (risk and safe zones) determined by a line guided by superficial anatomical landmarks. Its application when surgeons plan and perform posterior leg approaches will help to avoid iatrogenic nerve injuries.
LEVEL OF EVIDENCE
IV.
目的
已有多位作者描述了使用非比例数值距离预测腓肠神经通路的方法，但尚无作者提出一种具有解剖学参考的、可个体化且可重复的方法。本研究旨在通过超声描述体表参考线与腓肠神经位置之间的距离和交汇区。
方法
这是一项 2022 年 1 月至 4 月期间进行的描述性横截面研究，纳入符合纳入标准的需要行足部手术的患者。使用超声定位并标记小腿后侧的腓肠神经。从内侧股骨髁到腓骨尖端画一条直线作为体表标志线。通过将线的远端二等分，在小腿上建立 4 个相等的区域。这样，就可以为每个患者研究基于简单解剖比例的区域。在这 4 个区域测量标记线与超声神经位置之间的距离，创建交点和安全区。评估腓肠神经与建议的体表标志之间的位置和距离。
结果
共纳入 52 例患者的 104 条下肢，其中左侧 52 条，右侧 52 条。腓肠神经通过的最短距离为 2.9mm，位于第 2 点。腓肠神经交叉点 60/104（57.7%）位于 B 区，21/104（20.1%）位于 C 区，19/104（18.3%）位于 A 区。建立了安全区。在比较每位患者的双腿时，发现小腿远端腓肠神经相对于体表参考线的定位平均有 80.5%的重合。
结论
本研究提出了一种简单、可重复、无创的方法，首次根据体表浅在解剖标志引导的线，描述了腓肠神经的主要交汇区域的距离和位置（风险和安全区）。当外科医生规划和实施小腿后入路时，应用该方法有助于避免医源性神经损伤。
证据等级
IV。
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