PDF(Pubmed)
Abstract：
Perineural anesthesia of the tibial nerve can be performed ultrasound-guided or blindly, with the latter still being commonly used in equine practice due to practical constraints, despite its lower accuracy and hence, common failure to achieve desensitization. This may be associated with anatomical variations or inadequate landmarks for injection. To examine the course of the tibial nerve, document potential anatomical variations, and determine optimal landmarks for perineural injection, dissection was conducted along the medial aspect of the tibia in 10 paired cadaver hindlimbs. No anatomical variations of the tibial nerve were observed. Mean tibial nerve thickness was 6 ± 1 mm. The junction with the plantar nerves was located at a maximum of 85 mm and the junction with the medial cutaneous branch was at a maximum of 150 mm proximal to the proximal aspect of the calcaneal tubercle. The mean distance of the tibial nerve to the cranial border of the superficial digital flexor was 11 ± 6 mm. In conclusion, problems with perineural anesthesia of the tibial nerve cannot simply be attributed to anatomical variations. The thickness of the nerve and the amount of perineural tissue may present specific challenges for achieving adequate desensitization. Our results support the generally recommended site for tibial nerve perineural injection at 100 mm proximal to the calcaneal tubercle and 11 mm cranial to the superficial digital flexor.
摘要：
胫神经的硬膜外麻醉可以在超声引导下或盲目地进行，由于实际的限制，后者仍然普遍用于马的实践中，尽管它的精度较低，因此，实现脱敏的常见故障。这可能与解剖变化或用于注射的标记不足相关联。为了检查胫神经的走向，记录潜在的解剖学变化，并确定神经周注射的最佳标志，解剖是在10对尸体后肢的胫骨内侧进行的。没有观察到胫神经的解剖学变异。平均胫神经厚度为6±1mm。与足底神经的交界处最大为85mm，与内侧皮肤分支的交界处最大为跟骨结节近侧的150mm。胫神经与浅表指屈肌颅缘的平均距离为11±6mm。总之,胫神经周围麻醉的问题不能简单地归因于解剖学变化。神经的厚度和神经周组织的量可能对实现足够的脱敏提出特定的挑战。我们的结果支持通常推荐的向跟骨结节近端100mm和向浅表指屈11mm的胫神经神经注射部位。
