胫骨骨膜的神经支配及分布模式研究

doi:10.13418/j.issn.1001-165x.2025.5.01

PDF(2966 KB)

中国临床解剖学杂志 ›› 2025, Vol. 43 ›› Issue (5) : 499-503. DOI: 10.13418/j.issn.1001-165x.2025.5.01

应用解剖

胫骨骨膜的神经支配及分布模式研究

吴俊檄¹，樊锐²，杨波²，曾雪²，余虹²，熊鑫鑫²，黎小池¹，杨胜波¹*

作者信息 +

Study on the innervation and intraperiosteal nerve distribution pattern of the tibial periosteum

Wu Junxi¹, Fan Rui², Yang Bo², Zeng Xue², Yu Hong², Xiong Xinxin², Li Xiaochi¹, Yang Shengbo¹*

Author information +

文章历史 +

摘要

目的揭示胫骨骨膜的神经支配及整体分布模式。方法 12具中国成人尸体。大体解剖观察胫骨骨膜神经的来源及走行，改良的Sihler's染色法显示骨膜内神经的整体分布模式。结果胫骨骨膜神经支配为多节段来源。胫骨内侧面的骨膜主要由隐神经支配，外侧面主要由腓深神经的直接分支和胫骨前肌神经穿支支配，后面由胫神经的直接分支和母长屈肌神经穿支支配。神经进入骨膜后的树枝样分支，以胫骨骨膜内侧面和外侧面的中1/3部、后面的下1/3部分布最为密集，分支之间存在交通。结论这些结果可为胫骨骨膜移植促进神经功能重建的选材匹配、避免手术损伤其骨膜神经以及骨膜内镇痛药物注射靶点选择等提供形态学指导。

Abstract

Objective To reveal the innervation and intraperiosteal overall nerve distribution pattern of the tibial periosteum. Methods Twelve Chinese adult specimens were used to observe the origin and course of nerve of the tibial periosteum through gross dissection. The Modified Sihler's staining was used for showing the intraperiosteal overall nerve distribution pattern in tibial periosteum. Results The innervation of the tibial periosteum originated from multiple segments. The medial surface of tibial periosteum was mainly innervated by the saphenous nerve, lateral surface was mainly innervated by the direct branch of the deep peroneal nerve and the perforator nerve of the anterior tibial muscle, and posterior surface was innervated by the direct branch of the tibial nerve and the perforator nerve of the extensor hallucis longus muscle. The arborized branches of nerve after entering the periosteum were most densely distributed in the middle one-third of the medial and lateral surface of tibial periosteum and lower one-third of the posterior surface of tibial periosteum, with communication between the branches. Conclusions These results may provide morphological guidance for region matching of nerve function reconstruction during tibial periosteum transplantation, avoiding surgical injury to the periosteal nerves, and selection of targets during intraperiosteal injection of analgesic drugs.

导出引用

吴俊檄, 樊锐, 杨波, 曾雪, 余虹, 熊鑫鑫, 黎小池, 杨胜波. 胫骨骨膜的神经支配及分布模式研究[J]. 中国临床解剖学杂志. 2025, 43(5): 499-503 https://doi.org/10.13418/j.issn.1001-165x.2025.5.01

Wu Junxi, Fan Rui, Yang Bo, Zeng Xue, Yu Hong, Xiong Xinxin, Li Xiaochi, Yang Shengbo. Study on the innervation and intraperiosteal nerve distribution pattern of the tibial periosteum [J]. Chinese Journal of Clinical Anatomy. 2025, 43(5): 499-503 https://doi.org/10.13418/j.issn.1001-165x.2025.5.01

中图分类号： R322

参考文献

[1] Li J, Zhang Z, Tang J, et al. Emerging roles of nerve-bone axis in modulating skeletal system[J]. Med Res Rev, 2024, 44(4):1867-1903. DOI: 10.1002/med.22031.
[2] Wan QQ, Qin WP, Ma YX, et al. Crosstalk between Bone and Nerves within Bone[J]. Adv Sci (Weinh), 2021, 8(7):2003390. DOI: 10.1002/advs.202003390.
[3] Utagawa K, Shin T, Yamada H, et al. Three-dimensional visualization of neural networks inside bone by Osteo-DISCO protocol and alteration of bone remodeling by surgical nerve ablation[J]. Sci Rep. 2023, 13(1):4674. DOI: 10.1038/s41598-023- 30492-4.
[4] Li J, Ahmad T, Spetea M, et al. Bone reinnervation after fracture: a study in the rat[J]. J Bone Miner Res, 2001, 16(8):1505-1510. DOI: 10.1359/jbmr.2001.16.8.1505.
[5] Piet J, Hu D, Baron R, et al. Bone adaptation compensates resorption when sciatic neurectomy is followed by low magnitude induced loading[J]. Bone, 2019, 120:487-494. DOI: 10.1016/j.bone.2018.12.017.
[6] Liu W, Chen W, Xie M, et al. Traumatic brain injury stimulates sympathetic tone-mediated bone marrow myelopoiesis to favor fracture healing[J]. Signal Transduct Target Ther. 2023, 8(1):260. DOI: 10.1038/s41392-023-01457-w.
[7] Chen Y, Guo B, Ma G, et al. Sensory nerve regulation of bone homeostasis: Emerging therapeutic opportunities for bone-related diseases[J]. Ageing Res Rev, 2024, 99:102372. DOI: 10.1016/j.arr.2024.102372.
[8] O-Sullivan I, Kc R, Singh G, et al. Sensory Neuron-Specific Deletion of Tropomyosin Receptor Kinase A (TrkA) in Mice Abolishes Osteoarthritis (OA) Pain via NGF/TrkA Intervention of Peripheral Sensitization[J]. Int J Mol Sci. 2022, 23(20):12076. DOI: 10.3390/ ijms232012076.
[9] Tran DQ, Salinas FV, Benzon HT, et al. Lower extremity regional anesthesia: essentials of our current understanding[J]. Reg Anesth Pain Med, 2019, 11:rapm-2018-000019. DOI: 10.1136/rapm-2018-000019.
[10]Steverink JG, Oostinga D, van Tol FR, et al. Sensory Innervation of Human Bone: An Immunohistochemical Study to Further Understand Bone Pain[J]. J Pain, 2021, 22(11):1385- 1395. DOI: 10.1016/j.jpain.2021.04.006.
[11]Lorenz MR, Brazill JM, Beeve AT, et al. A Neuroskeletal Atlas: Spatial Mapping and Contextualization of Axon Subtypes Innervating the Long Bones of C3H and B6 Mice[J]. J Bone Miner Res, 2021, 36(5):1012-1025. DOI: 10.1002/jbmr.4273.
[12]Kim JH, Shustorovich A, Arel AT, et al. Genicular Nerve Anatomy and Its Implication for New Procedural Approaches for Knee Joint Denervation: A Cadaveric Study[J]. Pain Med, 2022, 23(1):144-151. DOI: 10.1093/pm/pnab238.
[13]Gustafson KJ, Grinberg Y, Joseph S, et al. Human distal sciatic nerve fascicular anatomy: implications for ankle control using nerve-cuff electrodes[J]. J Rehabil Res Dev, 2012, 49(2): 309-321. DOI: 10.1682/jrrd.2010.10.0201.
[14]Flanigan RM, DiGiovanni BF. Peripheral nerve entrapments of the lower leg, ankle, and foot[J]. Foot Ankle Clin, 2011, 16(2):255-274. DOI: 10.1016/j.fcl.2011.01.006.
[15]Li H, Zhu W, Wu S, et al. Anatomical analysis of antebrachial cutaneous nerve distribution pattern and its clinical implications for sensory reconstruction[J]. PLoS One, 2019, 14(9): e0222335. DOI: 10.1371/journal.pone.0222335.
[16] 王庆, 朱德意, 李小鹏, 等. 股部皮神经的整体分布模式及在感觉重建术中的意义[J]. 中国临床解剖学杂志, 2020, 38(5):540-544.DOI:10.13418/j.issn.1001-165x.2020.05.009.
Wang Q, Zhu DY, Li XP, et al. The whole-mount distribution pattern of femoral cutaneous nerve and its significance in sensory reconstruction [J]. Chin J Clin Anat, 2020,38(5):540-544.DOI:10.13418/j.issn.1001-165x.2020.05.009.
[17] 王磊, 史敬存. 同期神经化血管化髂骨瓣修复下颌骨及神经缺损[J]. 口腔疾病防治, 2023, 31(9):609-617.DOI:10.12016/j.issn.2096-1456.2023.09.001.
Wang L, Shi JC. Simultaneous innervated and vascularized iliac bone flap for reconstructingmandible and nerve defects[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2023, 31(9):609-617.DOI:10.12016/j.issn.2096-1456.2023.09.001.
[18]Cao S, Ji W, Zan Q, et al. Evaluation of the efficacy of autogenous tibial periosteal bone grafting in the treatment of osteochondral lesions of the talus and analysis of three-dimensional factors in the necrotic zone[J]. Int Orthop, 2024, 48(7):1831-1838. DOI: 10.1007/s00264-024-06161-0.
[19]Soldado F, Barrera-Ochoa S, Bergua-Domingo JM, et al. Bone nonunion management in children with a vascularized tibial periosteal graft[J]. Microsurgery, 2020, 40(7):760-765. DOI: 10.1002/micr.30655.
[20]Du MH, Ding Y, Shi X, et al. The Periosteal Autografts Transplantation for Cartilage Defects of the Hip in Older Children With Developmental Dysplasia as an Adjunctive Procedure[J]. Medicine (Baltimore), 2016, 95(17):e3432. DOI: 10.1097/MD.0000000000003432.
[21]Klymenko A, Lutz D. Melatonin signalling in Schwann cells during neuroregeneration[J]. Front Cell Dev Biol, 2022, 10:999322. DOI: 10.3389/fcell.2022.999322.
[22]Shu Y, Tan Z, Pan Z, et al. Inhibition of inflammatory osteoclasts accelerates callus remodeling in osteoporotic fractures by enhancing CGRP+TrkA+ signaling[J]. Cell Death Differ. 2024, 31(12):1695-1706. DOI: 10.1038/s41418-024-01368-5.
[23]Chaturvedi R, Bulat E, Cushman J, et al. Ultrasound-guided periosteal injection for the treatment of bony cancer pain: a retrospective cohort study[J]. Pain Med, 2023, 4(12):1399- 1400. DOI: 10.1093/pm/pnad094.
[24] 赵达锋, 冯进益, 陈艺敏, 等. 桡神经浅支联合骨膜神经阻滞麻醉在桡骨远端骨折手法复位中的应用[J].中国骨与关节损伤杂志, 2018, 33(5): 524-525. DOI:10.7531/j.issn. 1672-9935.2018.05.026.
Zhao DF, Feng JY, Chen YM, et al. Application of superficial radial nerve combined with periosteal nerve block anesthesia in manual reduction of distal radius fractures [J]. Chin J Bone Joint Injury, 2018, 33(5):524-525. DOI:10.7531/j.issn. 1672-9935.2018.05.026.
[25]Padhiar N, Curtin M, Aweid O, et al. The effectiveness of PROLOTHERAPY for recalcitrant Medial TIBIAL Stress Syndrome: a prospective consecutive CASE series[J]. J Foot Ankle Res, 2021, 14(1):32. DOI: 10.1186/s13047-021-00453-z.
[26]Tageldin ME, Alrashid M, Khoriati AA, et al. Periosteal nerve blocks for distal radius and ulna fracture manipulation--the technique and early results[J]. J Orthop Surg Res, 2015, 10:134. DOI: 10.1186/s13018-015-0277-6.