胫神经束组及其血供的解剖学研究
Applied anatomy of the tibial nerve and its blood supply
目的 观察小腿段胫神经束组及其血供,为小腿段胫神经损伤修复或游离移植提供解剖学依据。 方法 ①成人小腿标本26侧,分离胫神经主干及主要肌支,观察和测定各支横径、长度、起始位置、神经束无损伤分离长度。② 4侧新鲜成人小腿标本分别行动脉乳胶及墨汁灌注并制作透明标本,观察胫神经营养动脉。③ 4侧新鲜成人小腿标本上,死亡4 h内取下胫神经及分支并行胆碱酯酶染色,观察胫神经感觉束、运动束分布。 结果 胫神经主要肌支均在小腿8/8~6/8段分出,5/8~1/8段无重要肌支发出;胫神经干中内侧束组、外侧束组自然分束的距离长,平均为(361.4±7.1) mm;胫神经营养动脉丰富,胫后动脉与胫神经全程伴行,为其主要营养动脉;7/8~5/8段主要来自腓动脉,5/8~1/8段主要来自胫后动脉;胫神经内、外侧束组有相对独立的、完善的血供系统。 结论 胫神经上述解剖学特点为小腿部胫神经损伤的修复提供一定解剖学依据。小腿5/8~1/8段胫神经束组具有独立和完善血供系统,内外侧束组无损伤分离长度长,具备了带血供游离移植的供体神经解剖学特点。
Objective To explore anatomic features of the tibial nerve and its blood supply for nerve injury and nerve transplantation. Methods ① 26 fixed adult lower limber specimens were used in this study. The tibial nerve and branches were dissected. The diameter, length, origin location and the course of tibial nerve were measured and analyzed. ② 4 fresh adult lower limber specimens were injected with red lactoprene and Indian ink, followed by the transparent procedure and dissociation of tibial nerve and its nutrient vessel for observing its blood supply pattern. ③ Tibial nerve and its branches were dissected quickly from another 4 fresh adult specimens. Cholinesterase staining was performed to identify sensory bundles and motor bundles respectively. Results The vital muscular branches of the tibial nerve originated from the upper part of the leg. The medial and lateral cords coursed a long distance. The blood supply of tibial nerve was sufficient, with the proximal 7/8-5/8 part from peroneal artery, and the distal 5/8-1/8 part from posterior tibial artery. Posterior tibial artery closed to the nerve during its course. Each bundle had it's own special vessel blood. Conclusions Our data provide anatomic basis for tibial nerve injury repairing. The distal segment of medial cord of tibial nerve is valuable for the vascularized nerve grafts, for its independent and complete blood supply.
Tibial nerve / Applied anatomy / Blood supply / The bundle of tibial nerve
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