胫神经腓肠肌运动支的超声显示及定位  

Ultrasonographic Features and Ultrasound-guided Localizations of Tibial Nerve Motor Branches

作　　者：吴赤球[1] 余丹[2] 马忠武 高坚[2] 居秀君[1] 方莹[1] 沈国理[4] 

机构地区：[1]武警浙江总队杭州医院特检科,杭州市310051 [2]武警浙江总队杭州医院脑损伤康复中心 [3]武警浙江总队嘉兴医院特检科 [4]武警浙江总队杭州医院设备科,杭州市310051

出　　处：《中国超声医学杂志》2010年第10期953-955,共3页Chinese Journal of Ultrasound in Medicine

基　　金：浙江省医药卫生科学研究基金计划(No.2007B194)

摘　　要：目的探讨高频超声成像技术对胫神经腓肠肌运动支显示的可行性及定位的准确性,为超声引导(下同)腓肠肌神经运动支的阻滞治疗提供依据。方法应用高频超声成像技术,观察21例志愿者腓肠肌内、外侧头运动支的走行,分布及声像图特征。5例志愿者进行超声引导下电刺激验证,以确定超声定位的准确性。结果 (1)全部21例志愿者下肢腓肠肌运动支均有效显示,显示率100%;运动支的声像图特征为:横断面呈线状高回声包绕低回声的椭圆形或扁平状结构,其前后径和横径分别为(2.3±0.3)及(1.2±0.4)mm;纵切面呈2条线状高回声包夹低回声的条索状结构。运动神经肌支在肌门处进入肌肉后沿筋膜呈"树枝状"逐渐向下分支,起始部分成2～3条较大分支,向肌肉内、中、外侧亚部深入,并逐渐分成较细小的分支。(2)15例志愿者腓肠运动支由胫神经直接分出,6例存在变异情况,其中腓肠内侧头支与腓肠内侧皮神经共干者4例,腓肠肌外侧头肌支与比目鱼肌支共干者2例。(3)5例志愿者超声引导下电刺激验证,超声引导针尖均一次到达观察的目标神经,定位准确性100%。电刺激均引起腓肠肌有效收缩,电流强度为0.2～0.6mA。4例志愿者除穿刺针在穿破皮肤时有局部轻微疼痛外,其余在进针过程中,电刺激验证中及结束后均未见明显疼痛及麻木症状。1例腓肠内侧头支与腓肠内侧皮神经共干者伴有小腿皮肤的麻木感。结论高频超声可以清晰显示胫神经腓肠肌运动支,并能准确定位腓肠肌运动支主干及其运动分支,为腓肠肌神经运动支的阻滞治疗提供了理论基础。Objective To investigate the sonographic features of tibial nerve motor branches and to assess the accuration of ultrasound localization in tibial motor nerve branches. Methods 21 voluntees underwent high-resolution ultrasound examination of tibial nerve to gastrocnemius muscle. Ultrasound-guided tibial nerve branches localization was performed in 5 voluntees. The tibial nerve motor branches imagings and the needle advancement for nerve localization were dynamically recorded. Results Uhrasonography clearly detected the tibial nerve motor branches,which appeared as several parallel echogenic lines within two bold echogenic lines in longitudinal sections and as a reticular pattern with round hypoechoic surrounded by echogenic lines in transverse sections. The anteroposterior diameter and transverse diameter were （2.3±0.3） mm,（1. 2±0. 4） mm,respectively. The tibile motor nerve branched at the proximal aspect of gastroenemius muscle and distributeal along anadesma in the muscle. The nerve origination variations were detected in 6 volunteers including the medial sural cutaneous nerve originating from the nerve to the medial gastrocnemiu in 4 volunteers and the soleus muscle nerve originating from the nerve to the lateral gastrocnemiu in the other 2 volunteers. The needle advanced under direct ultrasound guidance to target nerves were successfully in 5 voluntees, the inten- sities of current to corresponding muscle contract were 0.2 mA -0.6 mA. No obvious complications occurred in all 5 volureers except slightly pain when puncture the skin and insensible feeling in 1 nerve variation volunteer. Conclusions High resolution uhrasonography can provide good quality tibial nerve motor branches images and locate the nerve accurately.

关 键 词：超声检查 胫神经 腓肠肌运动支 电刺激 

分 类 号：R445.1[医药卫生—影像医学与核医学]