基于Sihler’s技术的踝和足背皮神经的整体分布模式研究

doi:10.13418/j.issn.1001-165x.2022.4.03

摘要/Abstract

摘要： 目的揭示踝及足背皮神经的整体分布模式，为皮瓣移植感觉重建提供形态学指导。方法成年尸体24具，紧贴肌表面摘取含皮下脂肪的踝及足背皮肤，用改良的Sihler’s染色法显示并观察皮神经整体分布模式。结果在Sihler’s染色的标本中，肉眼可见隐神经支配踝前区（40.01±7.6）%、踝后区（30±6.7）%、以及部分足背内侧缘。腓浅神经支配踝前区（60.03±6.8）%，其足背内侧皮神经支配足背内侧区、第1、2趾背及第3趾背内侧半；95.83%的足背中间皮神经分布到第3趾背外侧半、第4、5趾背。腓肠神经支配踝后区（70±5.3）%，其足背外侧皮神经支配足背外侧缘皮肤。腓深神经分布到第1、2趾背相对面。初级神经支密度以踝前区最高，次级及以下神经支密度和总的神经支密度均以足背内侧区最高。结论在踝或足背的皮瓣移植中，建议把踝前区或足背内侧区设计为利于感觉重建的首选供区或感觉需求较高的受区。

关键词: 踝, , , 足背, , , 皮神经, , , 分布模式, , , 感觉重建

Abstract: To reveal the overview of distribution pattern of the ankle and dorsal foot cutaneous nerves, and provide morphological guidance for sensory reconstruction in skin flap transplantation. Methods The skin of ankle and dorsal foot with subcutaneous fat was removed from 24 adult cadavers, and the distribution pattern of cutaneous nerve was displayed by the modified Sihler's staining method. Results In the specimen stained with Sihler's staining, the distribution pattern of the cutaneous nerve branches can be seen by naked eyes. The saphenous nerve innervated (40.01±7.6) % of the anterior ankle, (30±6.7) % of the posterior ankle, and part of the medial border of the dorsal foot. The superficial peroneal nerve innervated the (60.03±6.8) % of anterior ankle. The medial dorsal cutaneous nerve innervated the medial dorsal foot, the dorsum of the first and second toe, and the medial half of dorsum of the third toe. 95.83 % of the intermediate dorsal cutaneous nerve innervated the lateral half of dorsum of the third toe, and the dorsum of the fourth and the fifth toe. The sural nerve innervated (70±5.3) % of the posterior ankle, and the dorsolateral cutaneous nerve innervated the dorsolateral border of the foot. The deep peroneal nerve distributed to the opposite side of the first and second toes. The density of the primary nerve branches was the highest in the anterior ankle, and the density of the secondary and subsequent nerve branches and the total nerve branches were the highest in the dorsomedial region of the foot. Conclusions In the flap transplantation of ankle or dorsal foot, it is suggested that the anterior ankle region or the medial dorsal foot region should be designed as the preferred donor site for sensory reconstruction or the recipient site with higher sensory needs.

Key words: Ankle, , , Dorsal foot, , , Cutaneous nerve, , , Distribution pattern, , , Sensory reconstruction

中图分类号:

R322

赖柏安, 李慧, 杨胜波. 基于Sihler’s技术的踝和足背皮神经的整体分布模式研究[J]. 中国临床解剖学杂志, 2022, 40(4): 387-393.

Lai Baian, Li Hui, Yang Shengbo, . Study on distribution pattern of cutaneous nerves of ankle and dorsal foot based on Sihler's technique[J]. Chinese Journal of Clinical Anatomy, 2022, 40(4): 387-393.

参考文献 23

[1]	崔慧先,李瑞锡.局部解剖学[M].北京:人民卫生出版社,2018:263-267.
[2]	Candan B, Albay S. Determination and classification of cutaneous innervation of the dorsum of the foot in foetal cadavers[J]. Folia Morphol (Warsz), 2018, 77(4):698-702. DOI: 10.5603/FM.a2018.0020.
[3]	Bas O, Bilgic S, Salbacak A, et al. Variations of the superficial peroneal nerve and its terminal branches in the Turkish newborn fetuses[J]. Turk Neurosurg, 2012, 22(1):62-67. DOI: 10.5137/1019-5149.
[4]	Drizenko A, Demondion X, Luyckx F, et al. The communicating branches between the sural and superficial peroneal nerves in the foot: a review of 55 cases[J]. Surg Radiol Anat, 2004, 26(6):447-452. DOI: 10.1007/s00276-004-0264-9. DOI: 10.1007/s00276-004-0264-9.
[5]	Wang T, Lin J, Song D, et al. Anatomical basis and design of the distally based lateral dorsal cutaneous neuro-lateral plantar venofasciocu taneous flap pedicled with the lateral plantar artery perforator of the fifth metatarsal bone: a cadaveric dissection[J]. Surg Radiol Anat, 2017, 39(2):141-147. DOI: 10.1007/s00276-016-1712-z.
[6]	蔡耘, 薛金伟, 刘永丹, 等. 通过皮肤活检评估健康成年人表皮神经纤维分布的数量特点[J].中华神经医学杂志, 2016, 15(11):1154-1158. DOI:10.3760/cma.j.issn.1671-8925.2016.11.013.
[7]	俞芳, 唐举玉, 吴攀峰, 等. 胫后动脉穿支蒂螺旋桨皮瓣修复小腿及足踝部皮肤软组织缺损[J].中华显微外科杂志, 2017, 40(5):419-423. DOI: 10.3760/cma.j.issn.1001-2036.2017.05.002
[8]	杨宪, 赵宏明, 杨胜波. 腹前外侧群肌的肌内神经分布模式[J].解剖学报,2019,50(1):77-81. DOI:10. 16098/j．issn. 0529-1356. 2019. 01. 013.
[9]	赵宏明, 杨宪, 杨胜波. 根据肌内神经分布定位髂腰肌和腰方肌痉挛的阻滞靶点[J]. 中国临床解剖学杂志, 2019, 37(1):5-8. DOI:10.13418/j.issn.1001-165x.2019.01.002.
[10]	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(10): e0223916. DOI: 10.1371/journal.pone.0223916.
[11]	Heo Y, Jung TJ, Yang M, et al. Distribution patterns of the cutaneous nerves on the dorsum of the foot and their clinical significance[J]. Clin Anat, 2020, 33(4):592-597. DOI: 10.1002/ca.23453.
[12]	王正理, 张天浩, 王之江, 等.踝前穿支蒂跨区供血皮瓣的设计与临床应用[J].中国临床解剖学杂志, 2020,38(2):146-149. DOI:10.13418/j.issn.1001-165x.2020.02.008.
[13]	吴晴晴, 肖灿, 林伟, 等.吻合神经的胫后动脉穿支螺旋桨皮瓣修复足内踝部软组织缺损[J].中国美容整形外科杂志, 2020, 31(3):153-156. DOI:10.3969/j.issn.1673-7040.2020.03.009.
[14]	吴迎,王先成,熊祥,等.带感觉神经的薄型股前外侧穿支皮瓣修复足背创面[J].中华整形外科杂志,2018,34(10):848-852. DOI:10.3760/cma.j.issn.1009-4598.2018.10.015.
[15]	魏在荣, 帅霞, 袁习平, 等.足背中间皮神经营养血管皮瓣对足背动脉皮瓣供区的修复[J].中华显微外科杂志, 2009, 32(4):287-289+355. DOI:10.3760/cma.j.issn.1001-2036.2009.04.010.
[16]	厉孟,刘旭东,刘兴炎,等.逆行足背内侧皮神经营养血管皮瓣急诊修复前足缺损[J].中华显微外科杂志,2008,31(05):341-343. DOI: 10.3760/cma.j.issn.1001-2036.2008.05.007.
[17]	Xu, YQ, Zhu, YL, Wu, NX, et al. Distal foot coverage with reverse dorsal pedal neurocutaneous flaps[J]. J Plast Reconstr Aesthet Surg, 2010, 63(1):164-169. DOI: 10.1016/j.bjps.2008.08.053.
[18]	梁雄华, 罗盛, 宋伟聪, 等.低旋转点和传统腓肠神经营养血管皮瓣修复足背、足跟软组织缺损的比较研究[J].中国医学创新, 2019,16(11):113-116. DOI:10.3969/j.issn.1674-4985.2019.11.030.
[19]	凌李, 李学渊, 沈华军, 等.足背超薄静脉皮瓣游离修复手指软组织缺损[J].中华手外科杂志, 2019, 35(6):452-455. DOI: 10.3760/cma.j.issn.1005-054X.2019.06.020.
[20]	朱永强,李瑞华,李津.复合足背皮瓣修复手背复合组织缺损的疗效观察[J].中国中西医结合外科杂志,2018,24(06):718-722. DOI:10.3969/j.issn.1007-6948.2018.06.009.
[21]	Ide C, Tohyama K, Yokota R, et al. Schwann cell basal lamina and nerve regeneration[J]. Brain Res, 1983, 288(1-2):61-75. DOI:10.1016/0006-8993(83)90081-1.
[22]	Feng SM, Wang AG, Zhang ZY, et al. Repair and sensory reconstruction of the children’s finger pulp defects with perforator pedicled propeller flap in proper digital artery[J]. Eur Rev Med Pharmacol Sci,2017,21(16):3533-3537. DOI:10.26355/eurrev_201708_ 13261.
[23]	Zhu L, Zhang J, Song X, et al. Sensory recovery of non-innervated free flaps and nasolabial island flaps used for tongue reconstruction of oncological defects. J Oral Rehabil, 2017, 44(10):736-748. DOI: 10.1111/joor.12510.