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目的对近端胫神经的肌支情况进行解剖学测量,探讨胫神经肌支转位治疗腓总神经高位损伤或长段损伤的手术可行性。方法选取12具(23侧)中性甲醛固定的成人下肢标本,解剖并测量胫神经近端各肌支的长度、入肌点处的直径、分支点至腓骨小头平面的距离(位置)及至腓骨颈的距离;从分叉部向近端膜内分离腓总神经的腓深、腓浅两部分,测量腓总神经可分离的最大长度以及腓深神经的直径。将腓深神经于分离的最高点处切断并模拟移位,观察胫神经肌支与腓深神经无张力缝合的可行性。结果胫神经近端主要肌支有比目鱼肌支、腓肠肌外侧头支和腓肠肌内侧头支,其长度分别为(53.2±9.9)、(36.3±9.6)和(44.7±8.6)mm;从分叉部向近端膜内分离腓总神经的最大长度为(59.3±7.2)mm;分离后,所有标本的比目鱼肌支和腓肠肌外侧头支以及21侧(91.3%)标本的腓肠肌内侧头支均可直接与腓深神经无张力地吻合。结论膜内分离腓总神经后,胫神经肌支转位治疗腓总神经长段损伤或高位损伤在解剖学上可行。综合考虑各肌支的长度和直径,比目鱼肌支是移位的最佳供体神经。
Objective To anatomize the muscular branches of the proximal tibial nerve and to explore the feasibility of tibial nerve myocarotid transposition for the treatment of the peroneal nerve injury or long segment injury. Methods Twelve adult (23 sides) samples of adult lower extremity fixed with formalin were dissected and dissected. The length of each branch of the proximal tibial nerve, the diameter at the entry point, the distance between the branch point and the fibular head and the distance Fibular neck distance; from the bifurcation to the proximal membrane separation of the peroneal perforation of the deep, fibular shallow two parts, measuring the common peroneal nerve can be separated the maximum length and diameter of the deep peroneal nerve. The peroneal nerve was cut off at the highest point of separation and simulated displacement, to observe the feasibility of tension-free suture of the tibial nerve branch and deep peroneal nerve. Results The main muscular branches of the proximal tibial nerve were soleus, lateral head of gastrocnemius and medial head of gastrocnemius with lengths of (53.2 ± 9.9), (36.3 ± 9.6) and (44.7 ± 8.6) mm, respectively. The maximal length of the common peroneal nerve was (59.3 ± 7.2) mm in the proximal membrane. After detachment, the medial head of gastrocnemius muscle of the soleus and gastrocnemius lateral branch of the specimens and the side of the gastrocnemius of 21 (91.3%) specimens could be directly Tight nerves with the deep anastomosis. Conclusion After dissecting the common peroneal nerve in the membrane, the tibiofemoral branch transposition can be anatomically feasible for the treatment of long or extensive injury of the common peroneal nerve. Considering the length and diameter of each muscle branch, the soleus muscle branch is the best donor nerve to shift.