Vermorel Pierre-Henri, Stordeur Alban, Grange Sylvain, Klasan Antonio, Philippot Rémi, Neri Thomas
Inter-university Laboratory of Human Movement Science, University Lyon - University Jean-Monnet Saint-Étienne, Saint-Étienne, France; Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne, EA 7424, France.
Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne, EA 7424, France.
J ISAKOS. 2024 Dec;9(6):100358. doi: 10.1016/j.jisako.2024.100358. Epub 2024 Nov 1.
Hamstring autografts are frequently used for ligament reconstruction surgery. Between 12% and 84% of patients report hypoesthesia or dysaesthesia secondary to injury of the saphenous nerve or one of its branches after hamstring harvesting. Type of incision (orientation and length) is subject of much regarding limiting the risk of nerve damage. A cadaveric study was performed to determine which type of incision limits the risk of injury to the saphenous nerve or one of its branches, based on an anatomic model for mapping nerve pathways at the harvest site.
An anatomical study was performed on 20 knees from 12 embalmed bodies. Distance between saphenous nerve branches and 4 points of interest along the tibial crest was measured. Based on these measurements, a digital model of the saphenous nerve and its branches was created. A model of three common types of incision (vertical, horizontal and oblique) was overlaid. Each incision was modeled for three lengths (2, 3, and 4 cm). Percentage of collision between nerve course model and incision model was then calculated to determine the risk of nerve damage for each type of incision. Based on the nerve course model, a 'low-collision-risk' safe zone was identified.
Nerve damage risk after an oblique incision was significantly lower than for a horizontal or vertical incision, for incision lengths of 3 and 4 cm (p < 0.05). For a specific incision orientation, the length of the incision did not affect the risk of nerve damage. A trapezoidal space close to the tibial crest and distal to the anterior tibial tuberosity appears to reduce risk of nerve damage.
This cadaveric study suggests that during hamstring harvesting, incisions shorter than 2 cm reduce the risk of saphenous nerve's branches injuries. For incisions longer than 2 cm, using an oblique incision may reduce the risk compared to vertical or horizontal incisions.
Level of evidence not applicable: Laboratory experiments.
腘绳肌自体移植物常用于韧带重建手术。12%至84%的患者报告称，在获取腘绳肌后，因隐神经或其分支之一受损而出现感觉减退或感觉异常。切口类型（方向和长度）是限制神经损伤风险的众多关注点之一。基于用于绘制取材部位神经通路的解剖模型，进行了一项尸体研究，以确定哪种切口类型可降低隐神经或其分支之一受损的风险。
对12具防腐尸体的20个膝关节进行解剖学研究。测量隐神经分支与沿胫骨嵴的4个感兴趣点之间的距离。基于这些测量结果，创建了隐神经及其分支的数字模型。叠加了三种常见切口类型（垂直、水平和斜向）的模型。每个切口模拟三种长度（2、3和4厘米）。然后计算神经走行模型与切口模型之间的碰撞百分比，以确定每种切口类型的神经损伤风险。基于神经走行模型，确定了一个“低碰撞风险”安全区。
对于3厘米和4厘米长的切口，斜向切口后的神经损伤风险显著低于水平或垂直切口（p<0.05）。对于特定的切口方向，切口长度不影响神经损伤风险。靠近胫骨嵴且位于胫骨前结节远端的梯形空间似乎可降低神经损伤风险。
这项尸体研究表明，在获取腘绳肌期间，小于2厘米的切口可降低隐神经分支损伤的风险。对于大于2厘米的切口，与垂直或水平切口相比，采用斜向切口可能会降低风险。
不适用的证据水平：实验室实验。
