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用于显微外科训练的鸡大腿坐骨神经的手术解剖与练习

Surgical Anatomy and Exercises Using the Chicken Thigh Sciatic Nerve for Microsurgery Training.

作者信息

Chong Alphonsus K S, Le Lan Anh T, Lahiri Amitabha, Yusoff Khadijah, Yip George W, Pan Feng, Teo Wendy, Liao Janice C Y, Lim Jin Xi

机构信息

Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore, Singapore.

Orthopaedics Centre, Raffles Hospital, Singapore, Singapore.

出版信息

J Hand Microsurg. 2022 Jul 6;15(5):365-370. doi: 10.1055/s-0042-1749444. eCollection 2023 Dec.

Abstract

Vessel repair in a chicken thigh is commonly used in microsurgery training model. The sciatic nerve is closely associated with the vessels and has been used for training nerve coaptation, which has different technical considerations from vessel anastomosis. We describe in detail the relevant surgical anatomy and training exercises that can be used with this model.  With 32 fresh store-bought chicken thighs, 16 were used to analyze the gross and histological features of the sciatic nerve, and 16 were intended to create and perform training models.  The average visible length of the nerve in the thigh was 51 mm (standard deviation [SD] 2.57 mm). The average diameter of the nerve was 2 mm (SD 0.33 mm) and was largest at its proximal end (3.21 mm, SD 0.27 mm). The nerve consistently branched into two along the chicken thigh, with more branching subsequently. This simulation model is appropriate not only for the classical end-to-end epineural suture, but also for advanced exercises, in terms of longitudinal fasciculus dissection, mismatched size nerve transfer, injured nerve preparation, and vein conduit technique. Dyeing of nerve fascicles enhanced the visibility of nerve surface quality.  The sciatic nerve in the chicken thigh is a suitable and accessible model for microsurgery training. The branching and fascicular patterns of the nerve lends itself well to both novice training and advanced simulation. We have incorporated this model into our training curricula.

摘要

鸡大腿血管修复常用于显微外科训练模型。坐骨神经与血管紧密相连,已被用于神经吻合训练,这与血管吻合有不同的技术考量。我们详细描述了可用于该模型的相关手术解剖结构和训练练习。

使用32个从商店购买的新鲜鸡大腿,其中16个用于分析坐骨神经的大体和组织学特征,16个用于创建和实施训练模型。

大腿中神经的平均可见长度为51毫米(标准差[SD]2.57毫米)。神经的平均直径为2毫米(SD 0.33毫米),在近端最大(3.21毫米,SD 0.27毫米)。神经在鸡大腿上始终分为两支,随后分支更多。就纵向束状解剖、大小不匹配的神经移植、损伤神经的处理和静脉导管技术而言,该模拟模型不仅适用于经典的端对端神经外膜缝合术,也适用于高级练习。神经束染色提高了神经表面质量的可视性。

鸡大腿中的坐骨神经是显微外科训练的合适且易于获取的模型。神经的分支和束状模式非常适合新手训练和高级模拟。我们已将该模型纳入我们的训练课程中。

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