胫神经腓肠肌肌支切断小腿减肥术应用解剖探讨  

Anatomical observation on nerve branches to triceps muscle of calf for calf reduction

作　　者：李希军[1] 柳大烈[1] 宋磊[1] 吴景泉[1] 单磊[1] 

机构地区：[1]南方医科大学珠江医院整形外科,广东广州510282

出　　处：《中国美容医学》2006年第3期262-264,i0003,共4页Chinese Journal of Aesthetic Medicine

摘　　要：目的:为临床胫神经腓肠肌肌支切断小腿减肥术提供形态学依据。方法:采用局部解剖学研究方法,观察测量胫神经在腘窝附近各分支走行位置、起点、长度及宽度。结果:胫神经在腘窝处发出4条主要分支:腓肠内侧皮神经、腓肠肌内侧头肌支、腓肠肌外侧头肌支和比目鱼肌肌支。变异情况主要有两种:①腓肠内侧皮神经与腓肠肌内侧头肌支共干起始(30%);②比目鱼肌肌支与腓肠肌外侧头肌支共干起始(30%)。腓肠肌内侧头肌支和腓肠肌外侧头肌支起点的平均高度分别为(-6.6±13.7)mm(、2.4±16.7)mm,神经起始处宽度分别为(2.3±0.4)mm(、2.5±0.4)mm,从起点到肌门处神经长度分别为(42±12)mm(、50±13)mm。结论:腓肠肌内、外侧头肌支从胫神经发出的位置比较恒定,神经较粗,较长,容易解剖分离。在腘窝皮肤皱褶处做长4～5cm横切口可暴露腓肠肌内、外侧头肌支。术中应注意神经变异情况,保护腓肠内侧皮神经和比目鱼肌肌支。Objective To provide basic applicable anatomy for clinical practical procedures of neurotomy of the motor branches of tibial nerve innervating the gastrocnemius for calf reduction. Methods Tibial nerve and nerve branches were dissected and explored at popliteal region for morphometry in 20 cadaver-legs. The length, width and the origination position of the nerve branches were measured and recorded. Results In most cases, there are 4 branches originated from the tibial nerve at popliteal region.They are motor branches innervating the medial gastrocnemius muscle,the lateral gastrocnemius muscle and the soleus muscle,and the medial sural cutaneous nerve.In 30% cases,the medial sural cutaneous nerve originates from the motor branch innervating the medial gastrocnemius muscle.In 30% cases,the nerve into the soleus muscle originates from the nerve into the lateral gastrocnemius muscle.The nerve to the medial gastrocnemius muscle and the nerve to the lateral gastrocnemius muscle branch off at （-6.6±13.7）mm and （2.4±16.7）mm; the width are （2.3±0.4）mm and （2.5±0.4）mm; the length are （42±12）mm and （50±13）mm. Conclusion The nerves to the medial and lateral gastrocnemius muscle originate from the tibial nerve at popliteal region.They are easily explored and detected through the incision of popliteal crease. The surgeon should keep in mind the nerve variation and avoid damaging the nerve to the soleus muscle and the medial sural cutaneous nerve.

关 键 词：小腿减肥 腓肠肌 胫神经 解剖 

分 类 号：R622[医药卫生—整形外科]