Mochida H, Kikuchi S
Department of Orthopedic Surgery, Fukushima Medical College, Japan.
Clin Orthop Relat Res. 1995 Nov(320):88-94.
Injury to the infrapatellar branch of the saphenous nerve has been reported as a complication of arthroscopic examination and surgery of the knee. The authors studied the anatomic distribution of this branch in cadavers, and investigated the incidence of this complication in 68 patients. The results of anatomic study showed that blind puncture is safe within an approximate 30-mm area from the medial margin of the patella at the level of midpatella, and within an approximate 10-mm area from the medial margin of the patellar ligament at the level of the distal pole of the patella. In 30% of examined cadavers, the infrapatellar branch of the saphenous nerve transverses and runs laterally before it crosses the proximal edge of the tibia. Anatomic findings indicated that blind puncture to the knee in a 90 degrees flexion position should be done horizontally and parallel to the articular surface to reduce the incidence of nerve injury. The results of this study of patients who had arthroscopy from 1990 to 1991 revealed a 22.2% incidence rate of sensory disturbances in the area where the infrapatellar branch is distributed. The incidence can be minimized by clarifying the distribution of the infrapatellar nerve branch in relation to palpable landmarks.
据报道，隐神经髌下支损伤是膝关节关节镜检查及手术的一种并发症。作者研究了该分支在尸体中的解剖分布，并调查了68例患者中此并发症的发生率。解剖学研究结果表明，在髌骨中点水平距髌骨内侧缘约30毫米的区域内，以及在髌骨远端水平距髌韧带内侧缘约10毫米的区域内进行盲目穿刺是安全的。在30%的受试尸体中，隐神经髌下支在穿过胫骨近端边缘之前横向并向外侧走行。解剖学发现提示，在膝关节屈曲90度位进行盲目穿刺时应与关节面平行且水平进针，以降低神经损伤的发生率。对1990年至1991年接受关节镜检查的患者的研究结果显示，髌下支分布区域感觉障碍的发生率为22.2%。通过明确髌下神经分支相对于可触及标志的分布，可将该发生率降至最低。
