目的 观察并测量外侧支持带神经（lateral retinacular nerve，LRN）的临床解剖学参数，探讨LRN的体表定位方法，为膝关节前外侧疼痛的诊治提供解剖依据。 方法 随机选取17具正常成年尸体下肢（34侧）进行解剖，确定坐骨神经（sciatic nerve，SN）的位置、走形和主要分支，选取位于膝关节后方的分支膝上外侧神经（SLGN）进行研究。追踪SLGN走形确认其第一个分支LRN，测量LRN分叉点分别到外侧胫股关节关节线与股骨外上髁的外侧端两个测量点的距离，从而确定LRN在体表的定位标志，并验证其准确性。 结果 LRN分叉点到第1个测量点的平均距离为（55.00±3.22）mm，到第2个测量点（26.00±2.42）mm。有性别差异，男性LRN分叉点到第1测量点平均（57.00±3.64）mm，到第2测量点平均（27.00±2.72）mm；女性分别为（51.00±1.14）mm，（23.00±0.54）mm。对两个定位标志的准确性评估，第1测量点（55.00 mm）准确率为100%，第2测量点（26.00 mm）准确率为67%。 结论 LRN在体表有两个较为可靠的定位标志，准确定位LRN并描述其路径，可以为诊治外侧膝关节疼痛提供理论依据。
Abstract
Objective To observe and measure the lateral retinacular nerve (LRN) in order to facilitate diagnostic and therapeutic nerve block and treatment for anterolateral knee pain. Methods Total 34 lower limbs had been dissected from 17 normal adult specimens. The exact location and main branches of the sciatic nerve (SN) were observed by specimen dissection. The posterior branch of the knee, superior lateral genicular nerve (SLGN) was dissected. Its first branch LRN was determined by tracing to the end. The first measurement point was the position from LRN branch of SLGN to the lateral tibiofemoral knee line. The second measurement point was the position from LRN branch of SLGN to the top of the external epicondyle of femur. Results The average distance of the first measuring point was (55.00±3.22) mm. The average distance of the second measuring point was (26.00±2.42) mm. There was gender differences. In which, the average distance of the first measurement point in male was (57.00±3.64) mm, and the average distance of the second measurement point in male was (27.00±2.72) mm. The average distance of the two measurement points in female was (51.00±1.14) mm, (23.00±0.54) mm, respectively. The evaluation of the two measurement points showed that, the probability of the first measurement point locating in knee joint was 100%, while the probability of the second measurement point locating in knee joint was 67%. Conclusions The study provides two dependable landmarks and a description of the path of the LRN making it possible to target the lateral retinacular nerve to diagnose and alleviate lateral knee pain.
关键词
外侧支持带神经 /
膝关节 /
解剖学测量
Key words
The lateral retinacular nerve /
Knee joint /
Anatomical measurement
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Houston TK, Connors RL, Cutler N, et al. A primary care musculoskeletal clinic for residents: success and sustainability[J]. J Gen Intern Med, 2004 19(5 Pt 2): 524-529.
[2] Collado H, Fredericson M. Patellofemoral pain syndrome[J]. Clin Sports Med, 2010, 29(3): 379-398.
[3] Piva SR, Fitzgerald K, Irrgang JJ, et al. Reliability of measures of impairments associated with patellofemoral pain syndrome[J]. BMC Musculoskelet Disord, 2006, 7(1): 33.
[4] Fulkerson JP, Tennant R, Jaivin JS, et al. Histologic evidence of retinacular nerve injury associated with patellofemoral malalignment[J]. Clin Orthop Relat Res, 1985, 7(197): 196-205.
[5] Fulkerson JP. Diagnosis and treatment of patients with patellofemoral pain[J]. Am J Sports Med, 2002, 30(3): 447-456.
[6] Merican AM, Amis AA. Anatomy of the lateral retinaculum of the knee[J]. J Bone Joint Surg Br, 2008, 90(4): 527-534.
[7] Sanchis-Alfonso V, Rosello-Sastre E, Martinez-Sanjuan V. Pathogenesis of anterior knee pain syndrome and functional patellofemoral instability in the active young[J]. Am J Knee Surg, 1999, 12(1): 29-40.
[8] Callaghan MJ, Oldham JA. The role of quadriceps exercise in the treatment of patellofemoral pain syndrome[J]. Sports Med, 1996, 21(5): 384-391.
[9] Kowall MG, Kolk G, Nuber GW, et al. Patellar taping in the treatment of patellofemoral pain. A prospective randomized study[J]. Am J Sports Med, 1996, 24(1): 61-66.
[10]Clifton R, Ng CY, Nutton RW. What is the role of lateral retinacular release[J] J Bone Joint Surg Br, 2010, 92(1): 1-6.
[11]Felson DT. The sources of pain in knee osteoarthritis[J]. Curr Opin Rheumatol, 2005, 17(5): 624-628.
[12]Horner G, Dellon AL. Innvervation of the human knee joint and implications for surgery[J]. Clin Orthop Relat Res, 1994, 9(301): 221-226.
[13]Huberti HH, Hayes WC. Contact pressures in chondromalacia patellae and the effects of capsular reconstructive procedures[J]. J Orthop Res, 1988, 6(4): 499-508.
[14]Noyes, FR. Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes[J]. Elselvier, Knee Pain of Neural Origin, 2009: 1096-1108.
[15]Nahabedian MY, Johnson CA. Operative management of neuromatous knee pain: patient selection and outcome[J]. Ann Plast Surg, 2001, 46(1): 15-22.
[16]Choi WJ, Hwang SJ, Song JG, et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial[J]. Pain, 2011, 152(3): 481-487.
京ICP备08002354号-3
