据报道,胫骨神经(TN)的分支模式接近其在脚上的末端,有相当大的变化。为了理解足跟疼痛的临床解剖结构,必须意识到与TN末端分支模式(靠近骨隧道)有关的所有可能变化。进行本研究是为了对足部胫神经分支的变化进行全面审查,特别是对这些分支的感觉分布的影响。使用相关关键字在主要的在线索引数据库中搜索文章。TN终止的模式被标记为三分叉或分叉。分叉模式更常见,并且与内侧跟骨神经(MCN)相关,相对于tal骨隧道高或低。最常见的分叉类型是在踝-跟骨轴的近端,但在骨隧道内。在文献中报道的所有五种类型的分叉中,TN的终止点的范围从踝-跟骨轴的近端3cm到远端3cm,因此该区域以外的区域可以被认为是进行侵入性手术的安全区。MCN的起源在分叉和分叉模式上都显示出相当大的差异,这与起点的分支数(一/二/三)有关。观察到下跟骨神经(ICN)的起源变化相对较小,因为它主要是作为足底外侧神经(LPN)的分支出现,有时是在终止前从TN的直接分支出现。在踝关节内侧采取减压措施时,应牢记骨隧道中MCN的频繁变化。
Considerable variations have been reported regarding the branching pattern of tibial nerve (TN) close to its termination in foot. In order to comprehend the clinical anatomy of heel pain awareness of all the possible variations in relation to terminal branching pattern of TN (close to the tarsal tunnel) is essential. The present study was conducted to undertake a comprehensive
review of the variations in TN branches in foot with particular emphasis on the implications for sensory distribution of these branches. Articles were searched in major online indexed databases using relevant key words. The pattern of termination of TN was noted as either trifurcation or bifurcation. Bifurcation pattern was more commonly observed and is associated with the medial calcaneal nerve (MCN) either arising high or low relative to the tarsal tunnel. The most commonly noted type of bifurcation was proximal to malleolar-calcaneal axis but within the tarsal tunnel. Across all five types of bifurcation reported in literature, the termination points of TN ranged from 3 cm proximal to 3 cm distal to malleolar-calcaneal axis and, therefore, the area beyond this region can be considered as safe zone for performing invasive procedures. MCN showed considerable variations in its origin both in trifurcation and bifurcation pattern pertaining to number of branches (one/two/three) at the point of origin. The origin of inferior calcaneal nerve was observed to be relativelyless variable as it mostly arose as a branch of lateral plantar nerve and sometimes as a direct branch from TN before termination. The frequent variation of MCN in the tarsal tunnel should be kept in mind while undertaking decompression measures in medial ankle region.