Вариантная анатомия хода поднадколенниковой ветви подкожного нерва

Abstract

Abstract Background:With total endoprosthetics and multiple surgeries of a different nature in the area of the knee joint, neuropathic pain is observed in the postoperative rehabilitation period. With all kinds of access (for example, access by Textor or by Kornev), there is a high probability of crossing the popliteal branch of the saphenous nerve (ramus infrapatellaris). This precedent significantly affects the severity of the postoperative period. It is necessary to take into account the peculiarities of the topography of the saphenous nerve. Material and methods: The study was carried out on 7 lower extremities fixed in 10% formalin. We used methods of anatomical preparation and morphometry with a caliper with an accuracy of 0.1 mm. To determine the topography of these nerve structures, measurements of the course of n.saphenus, r.infrapatellaris were carried out, comparatively determined by palpation of anatomical bone structures. Results: Based on the data obtained during the measurements, we have determined all possible options for the distances from the points of the bony protrusions. We were convinced that the greatest variability is observed when measured from the medial edge of the patella, where, as a rule, the anteromedial approach in the knee joint is performed, which, in fact, indicates the greatest vulnerability of r.infrapatellarisn.saphenus in the anteromedial approach. Conclusions: The greatest variability of r.infrapatellaris occurs in the medial edge of the patella and when in the horizontal plane from the top point of the tibial tuberosity. Taking into account the widespread introduction of the anteromedial approach in operations on the knee joint and the large variability of the course of the infrapatellar branch, it can be concluded that this branch is most vulnerable to excision with the above approach.