收肌管下口处隐神经阻滞的应用解剖

李学谦, 卢立荣, 李鸿鹏, 孙赟, 张海东, 赵振美

中国临床解剖学杂志 ›› 2020, Vol. 38 ›› Issue (1) : 10-13.

中国临床解剖学杂志 ›› 2020, Vol. 38 ›› Issue (1) : 10-13. DOI: 10.13418/j.issn.1001-165x.2020.01.003
应用解剖

收肌管下口处隐神经阻滞的应用解剖

  • 李学谦, 卢立荣, 李鸿鹏, 孙赟, 张海东, 赵振美
作者信息 +

Applied anatomy of saphenous nerve block near to inferior foramen of adductor canal

  • LI Xue-qian, LU Li-rong, LI Hong-peng, SUN Yun, ZHANG Hai-dong, ZHAO Zhen-mei
Author information +
文章历史 +

摘要

目的 探讨收肌管下口处隐神经的精细解剖和体表定位。  方法 采用12具尸体标本20侧下肢对收肌管及其下口部位进行精细解剖和测量。  结果 收肌管下份隐神经在前内侧、股动脉居中、股静脉在后。在收肌管下口和稍上位置,膝降动、静脉和隐神经分别穿大收肌腱板出收肌管并伴行下行,隐神经在膝内侧缝匠肌腱和股薄肌腱之间穿深筋膜,伴大隐静脉下降至小腿和足内侧。收肌管下口分别距髌骨上缘(5.85±0.15)cm、髌骨底内侧缘(2.72±0.60)cm、股内侧皮肤表面(4.08±0.66)cm。  结论 髌骨上缘上5.85 cm、髌骨底内侧缘内2.72 cm、股内侧皮肤表面4.08 cm深处为收肌管下口隐神经阻滞的体表定位;股动脉是收肌管下口上隐神经阻滞的定位标志;膝降动脉的隐支是收肌管下口下隐神经阻滞的识别标志。

Abstract

Objective To explore the details of anatomy and surface localization of saphenous nerve near to inferior foramen of adductor canal. Methods Twenty sides of lower limb from 12 cadaver specimen were dissected to measure the key structures adjacent to the adductor canal. Results Saphenous nerve, femoral artery and femoral vein located in the anteromedial, medial and posterior part of adductor canal, respectively. At the site of the inferior foramen of adductor canal, the descending genicular artery, vein and saphenous nerve penetrated through adductor tendon plate and appeared in adductor canal, which were accompanied by the great saphenous vein. Saphenous nerve passed through deep fascia between sartorius tendon and gracilis tendon on the medial surface of knee, and descended to the medial surface of leg and foot. The distances from inferior foramen of adductor canal to superior border of patella, to medial margin of the patella, and to the medial surface of thigh skin were (5.85±0.15) cm, (2.72±0.60) cm and (4.08±0.66) cm, respectively. Conclusions Surface localization point of saphenous nerve block should be limited to a specific area, which is about 5.85 cm upper to the superior border of patella, 2.72 cm internal to medial margin of the patella, and 4.08 cm deep to the medial surface of thigh. For saphenous nerve blocking, femoral artery could be regarded as a localization mark above inferior foramen of adductor canal, while, the saphenous branch of the descending genicular artery as the localization mark below inferior foramen of adductor canal. 

关键词

收肌管下口 /  隐神经 /  膝降动脉 /  隐神经阻滞

Key words

Inferior foramen of adductor canal; Saphenous nerve; Descending genicular artery / Saphenous nerve block

引用本文

导出引用
李学谦, 卢立荣, 李鸿鹏, 孙赟, 张海东, 赵振美.
收肌管下口处隐神经阻滞的应用解剖
[J]. 中国临床解剖学杂志. 2020, 38(1): 10-13 https://doi.org/10.13418/j.issn.1001-165x.2020.01.003
LI Xue-qian, LU Li-rong, LI Hong-peng, SUN Yun, ZHANG Hai-dong, ZHAO Zhen-mei. Applied anatomy of saphenous nerve block near to inferior foramen of adductor canal[J]. Chinese Journal of Clinical Anatomy. 2020, 38(1): 10-13 https://doi.org/10.13418/j.issn.1001-165x.2020.01.003
中图分类号:      R323.72   

参考文献

[1]  Vora MU, Nicholas TA , Kassel CA, et al. Adductor canal block for knee surgical procedures: review article[J]. J Clin Anesth, 2016, 35(4): 295-303.
[2]  Kiasari AZ, Babaei A, Alipour A, et al. Comparison of hemodynamic changes in unilateral spinal anesthesia versus epidural anesthesia below the T10 sensory level in unilateral surgeries: a double-blind randomized clinical trial[J]. Med Arch, 2017, 71(4): 274-279.
[3] Standring S. Gray’s anatomy-the anatomical basis of clinical practice[M]. 41st ed. New York: Elsevier Churchill Livingstone, 2016: 1337, 1366.
[4] Saranteas T, Anagnostis G, Paraskeuopoulos T, et al. Anatomy and clinical implications of the ultrasound-guided subsartorial saphenous nerve block[J]. Reg Anesth Pain Med, 2011, 36(4): 399-402.
[5]  高士濂. 实用解剖图谱(下肢分册, 3版)[M]. 上海: 上海科学技术出版社, 2012: 134-135.
[6] Bendtsen TF, Moriggl B, Chan V, et al. Topography of the saphenous nerve in the femoral triangle and the adductor canal[J]. Reg Anesth Pain Med, 2015, 40(4): 391-392.
[7] Marian AA, Ranganath Y, Bayman EO, et al. A Comparison of 2 ultrasound-guided approaches to the saphenous nerve block: adductor canal versus distal transsartorial: a prospective, randomized, blinded, noninferiority trial[J]. Reg Anesth Pain Med, 2015, 40(5): 623-630.
[8] Bendtsen TF, Moriggl B, Chan V, et al. Defining adductor canal block[J]. Reg Anesth Pain Med, 2014, 39(3): 253-254. 
[9] Tubbs RS, Loukas M, Shoja MM, et al. Anatomy and potential clinical significance of the vastoadductor membrane[J]. Surg Radiol Anat, 2007, 29(7): 569-573.
[10]Elazab EEB. Morphological study and relations of the fascia vasto-adductoria[J]. Surg Radiol Anat, 2017, 39(10): 1085-1095. 
[11]Anagnostopoulou S, Anagnostis G, Saranteas T, et al. Saphenous and infrapatellar nerves at the adductor canal: anatomy and implications in regional anesthesia[J]. Orthopedics, 2016, 39(2): 259-262. 
[12]Lynch JR, Okoroha KR, Lizzio V, et al. Adductor canal block versus femoral nerve block for pain control after anterior cruciate ligament reconstruction: a prospective randomized trial[J]. Am J Sports Med, 2019, 47(2): 355-363.

基金

国家级大学生创新创业训练计划项目(201710439013)

收肌管下口处隐神经阻滞的应用解剖
" title="Share on Weibo" target="_blank">

Accesses

Citation

Detail

段落导航
相关文章

/