Zhao Anquan, Qi Yansong, Huang Qirimailatu, Tao Liyuan, Xu Yongsheng, Bao Huricha
Orthopedic Center, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia Autonomous Region, China.
Graduate School of Baotou Medical College, Inner Mongolia University of Science & Technology, Baotou, Inner Mongolia Autonomous Region, China.
Orthop J Sports Med. 2024 Mar 18;12(3):23259671241232639. doi: 10.1177/23259671241232639. eCollection 2024 Mar.
Detailed knowledge of the anatomic course of the common peroneal nerve (CPN) is crucial for the surgical treatment of the posterolateral corner (PLC) of the knee.
To investigate the relationship of the CPN to the PLC of the knee at different flexion angles.
Descriptive laboratory study.
Ten healthy volunteers were recruited to undergo magnetic resonance imaging (MRI) of the knee joint at knee flexion angles of 0°, 30°, 60°, 90°, and 120°. MRI scans at 3 levels (joint line, tibial cut, and fibular tip) were evaluated to determine (1) the distance from the CPN to the PLC and (2) the distances between the CPN and the anterior-posterior and medial-lateral tibial axes. A 3-dimensional model of the knee joint created from MRI scans of a single participant was used to simulate the creation of a fibular tunnel for PLC reconstruction and investigate the relationship between the CPN, fibular tunnel, and guide pin.
The CPN moved posteromedially with increased knee flexion angles. As the flexion angle increased, the distances from the CPN to the anterior-posterior axis and the PLC increased significantly, while the distance to the medial-lateral axis decreased significantly at all 3 measurement levels. The distances between the CPN and anterior-posterior and medial-lateral axes were significantly different among the different knee flexion angles at the different measurement levels. There were no significant differences in the mean distance from the CPN to the posterolateral border of the tibial plateau between 0° and 30° of flexion at the fibular tip level ( = .953). There were statistically significant differences in the distance from the CPN to the PLC of the tibial plateau at the different measurement levels. The 3-dimensional model demonstrated that the position of the CPN relative to the guide pin and the bone tunnel undergoes changes during knee flexion.
Changes in the knee flexion angle produced corresponding changes in the course of the CPN on the posterolateral aspect of the knee joint. The CPN moved posteromedially with increased knee flexion angles.
Increasing the knee flexion angle during PLC reconstruction can effectively avoid direct injury of the CPN.
详细了解腓总神经（CPN）的解剖走行对于膝关节后外侧角（PLC）的手术治疗至关重要。
研究不同屈膝角度下CPN与膝关节PLC的关系。
描述性实验室研究。
招募10名健康志愿者，在屈膝角度为0°、30°、60°、90°和120°时对膝关节进行磁共振成像（MRI）检查。对3个层面（关节线、胫骨截骨处和腓骨小头）的MRI扫描进行评估，以确定（1）CPN到PLC的距离，以及（2）CPN与胫骨前后轴和内外侧轴之间的距离。利用从一名参与者的MRI扫描创建的膝关节三维模型，模拟为PLC重建创建腓骨隧道，并研究CPN、腓骨隧道和导针之间的关系。
随着屈膝角度增加，CPN向后内侧移动。随着屈膝角度增加，在所有3个测量层面上，CPN到前后轴和PLC的距离显著增加，而到内外侧轴的距离显著减小。在不同测量层面，不同屈膝角度下CPN与前后轴和内外侧轴之间的距离存在显著差异。在腓骨小头水平，屈膝0°至30°时CPN到胫骨平台后外侧缘的平均距离无显著差异（P = 0.953）。在不同测量层面，CPN到胫骨平台PLC的距离存在统计学显著差异。三维模型显示，在屈膝过程中，CPN相对于导针和骨隧道的位置会发生变化。
屈膝角度的变化会使膝关节后外侧的CPN走行产生相应改变。随着屈膝角度增加，CPN向后内侧移动。
在PLC重建过程中增加屈膝角度可有效避免CPN直接损伤。
