踝管内胫后神经松解有关的应用解剖  

Applied anatomy of the posterior tibial nerve in the tarsal tunnel

作　　者：陈清汉[1] 陈德松[2] 方有生[2] 张树桧[1] 

机构地区：[1]河南医科大学第二附属医院骨科,河南郑州450003 [2]复旦大学附属华山医院手外科,上海200040

出　　处：《中国临床解剖学杂志》2001年第3期210-211,共2页Chinese Journal of Clinical Anatomy

摘　　要：目的 :为踝管内胫后神经松解治疗踝管综合征、跟痛症等提供解剖学基础。方法 :在 1 5例成人尸体标本 ,对胫后神经在踝管内的分支部位及其走行进行了解剖观察研究 ,测量了胫后神经的滑动距离。结果 :胫后神经多在内踝水平下 3cm内分出足底内、外侧神经支配足底部皮肤感觉及内在肌 ,少部分在内踝上分支。从胫神经主干内踝上 1cm内发出 1～ 2支神经 (跟内侧支 )在皮下或深筋膜下行走达足跟脂肪垫内及跟骨内 ,沿途呈树枝状分支。被动活动关节时 ,踝管内胫神经可滑动 8.2mm( 5.0～ 1 2 .5mm)。结论 :踝管内胫神经松解应充分松解胫神经的主干及主要分支 ,足跟分支卡压可能与足跟痛有关。故对顽固性足跟痛患者可考虑封闭、松解或切断有关神经支。Objective:To provide anatomic basis for the treatment of tarsal tunnel syndrome and heel pain.Methods:The course,branches of posterior tibial nerve in the tarsal tunnel were observed on 15 adult cadaver specimens,the gliding distance of tibial nerve were measured at the same time.Results:The posterior nerve were divided into two plantar medial nerve and plantar lateral nerve at 3 cm beneath the medial malleolus,then enter the plantar region of the foot,innervate the skin and intrinsic muscles.A small portion of tibial nerve divided into two branches in the superior medial malleolus.one or two branches(medial calcaneus nerve)were originated from the tibial nerve at about 1 cm beyond the medial malleolus,descending under the skin or deep fascia,entering the fat pad of the plantar region and calcaneus,dividing into branches like tree along its or their course.When the ankle joint moved passively the tibial nerve can gliding 5～ 12.5 mm (averaged 8.2 mm) in the tarsal tunnel.Conclusion:The tibial nerve and its main branches should be neurolysed thoroughly,entrapment of the medial calcaneus nerve may be related with the painful heel,local injection,neurolysis or ramisectomy could be advocated for the persistent painful heel.

关 键 词：踝管 胫后神经 应用解剖 踝管综合征 足跟痛 

分 类 号：R681.8[医药卫生—骨科学] R322.85[医药卫生—外科学]