The popliteal entrapment syndrome

Summary Five examples of the popliteal entrapment syndrome have been reported in 4 patients aged between 17 and 41. The diagnosis in each case was made pre-operatively. The anatomical anomalies consisted in three instances of an abnormally high insertion of the inner gemellus (medial head of gastrocnemius) muscle tendon with the artery located twice in front and once in the middle of the tendon, in another instance compression was due to a hypertrophic musculus plantaris and finally, in the last instance, the anomalies were caused by abnormal fibrous bands. In two instances the artery was thrombosed, in three it was compressed in an intermittent fashion. The patients responded well to treatment, by a graft in the case of thrombosis, and by sectioning the abnormal insertions of the gemellus muscle or the fibrous bands in the others. The frequency of these different anatomical types, the relative evolutivity and the embryological hypotheses are studied in the 111 cases recorded in the literature between 1970 and 1983.

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Le piège poplité

Résumé Cinq cas de poplitées piégées sont rapportés chez 4 patients dont l'âge était compris entre 17 et 41 ans. Le diagnostic a été fait dans chaque cas en pré-opératoire. Les anomalies anatomiques consistaient trois fois en une insertion anormalement haute du tendon du jumeau interne, l'artère siégeant 2 fois en avant et 1 fois au milieu du tendon, dans un cas en une compression par un muscle plantaire grêle hypertrophique, enfin dans le dernier cas, il s'agissait de bandes fibreuses anormales. Dans 2 cas, l'artère était thrombosée, dans 3 cas, elle était comprimée de façon intermittente. Les patients ont été traités avec succès par pontage en cas de thrombose, et par section des insertions anormales du jumeau interne ou des bandes fibreuses dans les autres cas. La fréquence des différents types anatomiques, l'évolutivité relative, et les hypothèses embryogénétiques sont étudiées à partir de 111 autres cas rapportés dans la littérature entre 1970 et 1983.

     

Popliteal artery entrapment syndrome: an unusual presentation of a fibular osteochondroma

This report describes a fibular neck osteochondroma presenting as popliteal artery entrapment syndrome.     

Popliteal vascular entrapment syndrome caused by variant lateral head of the gastrocnemius muscle leading to pulmonary artery embolism

A young man with popliteal vascular entrapment syndrome (PVES) presented with arterial occlusion, deep venous thrombosis (DVT), pulmonary artery embolism, and pulmonary hypertension. He received computer tomography (CT) and magnetic resonance imaging (MRI). Both CT and MRI showed that the left thrombosed popliteal vein and artery were entrapped by a variant lateral head of the gastrocnemius muscle. The anomalous slip originated from the lateral head of left gastrocnemius muscle and ended between the medial and lateral femoral condyles. PVES Type V was diagnosed. Compression of the popliteal vein without arterial compression can be explained by the more lateral location of the popliteal vein relative to the artery and its proximity to the lateral head of the gastrocnemius. Compression of the popliteal vein with arterial compression was found in this patient. Compression of popliteal vein and artery in this patient led to DVT and arterial occlusion. The case was the first reported case accompanied by popliteal vein and artery thrombosis caused by variant lateral head of the gastrocnemius muscle. Radiologists and doctors should continue to look for possible abnormalities in the popliteal fossa in young patients with peripheral vascular disease because early diagnosis of PVES allows better choices and outcomes of treatment. Clin. Anat. 25:986–988, 2012. © 2012 Wiley Periodicals, Inc.     

Median nerve entrapment. pronator teres syndrome

Summary The surgical anatomy of interest in the pronator teres syndrome was studied to shed light on the ramifying pattern of the median nerve, the number of its muscular branches and their branching levels and to pinpoint the location of the fibrous bands which may cause median nerve entrapment. The fibrous arch of the pronator teres muscle (pronator arch) was found to lie 3 cm to 7.5 cm below Hueter's line, that of the flexor digitorum superficialis muscle (superficialis arch), which is distal to the pronator arch, was found to lie 6.5 cm below Hueter's line in its most proximal position. Symptom patterns in terms of muscle weakness caused by median nerve entrapment at different levels were also evaluated.

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Compression du nerf médian. Syndrome du rond pronateur. Anatomie chirurgicale et corrélation aux tableaux cliniques

Résumé L'anatomie chirurgicale relative au syndrome du rond pronateur a été étudiée pour éclairer les modalités de ramification du n. médian, le nombre de ses branches musculaires et leur niveau d'origine, et pour préciser la situation des arcades fibreuses qui peuvent comprimer le n. médian. L'arcade fibreuse du m. rond pronateur a été trouvé'e à 3 à 7,5 cm au-dessous de la ligne de Hueter, celle du m. fléchisseur superficiel des doigts, qui est distale par rapport à celle du m. rond pronateur, a été retrouvée à 6,5 cm au-dessous de la ligne de Hueter dans sa position la plus proximale. Les tableaux cliniques de déficit musculaire causés par la compression du n. médian à divers niveaux sont également analysés.

     

腓肠肌外侧头附属肌束致腘血管陷迫综合征的影像学诊断

目的　探讨影像学检查方法在腓肠肌外侧头附属肌束致腘血管陷迫综合征（Popliteal 　vascular entrapment syndrome, PVES）中的诊断价值,增加对该病的认识。 方法　回顾性分析4例经手术病理证实的由腓肠肌外侧头附属肌束致腘血管陷迫综合征患者的影像学资料,包括多普勒超声、数字减影血管检查（DSA）、CT血管成像（CTA）及磁共振检查（MRI）。 结果　4例患者中,2例患者腘动脉受累闭塞;1例患者双侧腘静脉内移,左侧腘静脉血栓形成;1例患者左侧腘动静脉均受累,造成左侧腘动脉闭塞,左侧腘静脉及股静脉血栓形成,血栓脱落后造成肺动脉栓塞,慢性血栓栓塞性肺动脉高压及肺心病。4例患者中,超声及DSA检查均能够发现腘动脉及腘静脉的形态变化,术前未明确PVES诊断。CTA及　MRI检查能够清晰显示腘窝内腘血管与异常肌束间的关系,明确诊断,与手术结果一致。 结论　腓肠肌外侧头附属肌束致腘血管陷迫综合征是一种少见的疾病,影像学检查对于该病的诊断与治疗有重要价值。     

Popliteal artery entrapment syndrome

Popliteal artery entrapment is an unusual cause of intermittent claudication in young people. Despite increasing interest since the paper by (Hamming: Angiology 10:369–371, 1959) one may still fail to ascribe exercise-induced leg pain to this syndrome. It may be confused with a chronic posterior crural compartment syndrome or spinal stenosis. In this article two cases, occurring in young athletes who required reconstructive surgery, are presented.     

High and low lateral approaches to the popliteal artery

Summary Using a series of 20 dissections and two anatomic transverse sections of a lower limb, the authors investigated the lateral approaches to the popliteal artery. The high lateral approach (above the knee) is not very aggressive and gives access to the retro-genicular part of the popliteal artery. After cutaneous and fascial incision, a simple gap between the vastus lateralis and biceps femoris mm. allows easy exposure of the popliteal vessels after backward retraction of the sciatic nerve. The low lateral approach to the artery (below the knee) is very aggressive for the vessels, nerves, and ligaments of the area. It involves the resection of the upper fourth of the fibula and the isolation and protection of the common peroneal nerve Nevertheless, these lateral approaches must be known and used when classic approaches (medial and posteiror) are impossible.

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Voies d'abord latérales hautes et basses de l'artère poplitée

Résumé A partir d'une série de 20 dissections et de deux coupes horizontales d'un membre inférieur congelé, les auteurs ont réalisé une approache anatomique des voies d'abord latérales de l'artère poplitée. L'abord latéral haut de l'artère poplitée (au-dessus du genou) est peu traumatisant et permet d'atteindre la portion rétro-articulaire de l'artère poplitée. Après incision cutanée et fasciale, une simple discision entre les mm. vaste latéral et biceps fémoral permet une exposition aisée des vaisseaux poplités après écartement du n. sciatique en arrière. L'abord latéral bas de l'artère poplitée est très agressif sur les plans vasculaire, nerveux et ligamentaire. Il nécessite la résection du quart supérieur de la fibula en isolant et protégeant le n. fibulaire commun. Néanmoins, ces voies d'abord doivent être connues et utilisées en cas de contre-indication aux voies d'abord classiques (médiales et postérieures).

     

Anatomo-radiological study of the popliteal artery during knee flexion

Summary We studied the morphological modifications of the popliteal artery during knee flexion. An anatomical, radiological study consisted of analysis of lateral arteriographs in different degrees in joint flexion followed by dissection to reveal the anatomical structures involved in the morphological adaptation of the popliteal artery to joint movement. In five non-atheromatous volunteers, 15 MRI angiographic sequences were done at the level of the knee in extension and flexion. The arteriographs and angio MRI showed that as joint flexion increased tortuosities appeared in the supra-articular upper popliteal artery while the middle and lower parts of the popliteal artery kept an even curve retracted from the posteriror surface of the joint. Dissection seemed to show that this arterial adaptation occurred between two fixed points, one proximal (the adductor canal) and the other distal (the origin of the anterior tibial artery). Angio MRI seems to be a future route for the assessment of the limb vessels. The contrasting behaviour of the different segments of the popliteal artery allows us to understand better the pathophysiology of trauma and malpositions of the popliteal arterial trunk.

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Etude radio-anatomique de l'artère poplitée lors de la flexion du genou

Résumé Les auteurs ont étudié les modifications morphologiques de l'a. poplitée lors de la flexion du genou. L'étude radio-anatomique comporte l'analyse d'artériographies de profil pour différents degrés de flexion articulaire, puis des dissections pour objectiver les structures anatomiques en cause dans l'adaptation morphologique de l'a. poplitée au mouvement articulaire. Chez 5 sujets volontaires, non athéromateux, 15 séquences angiographiques en I.R.M. ont été réalisées au niveau des genoux en position d'extension et de flexion. Les artériographies et l'angio-I.R.M. montrent qu'au fur et à mesure que le degré de flexion articulaire augmente, des flexuosités apparaissent au niveau de l'a. poplitée haute supra-articulaire alors que les parties moyenne et basse de l'a. poplitée gardent une courbure harmonieuse, s'écartant du plan postérieur de l'articulation. Les dissections semblent montrer que cette adaptation artérielle se fait entre deux points fixes, l'un proximal : le canal des adducteurs, l'autre distal : l'origine de l'a. tibiale antérieure. L'angio-I.R.M. paraît une voie d'avenir dans l'exploration des vaisseaux des membres. L'opposition comportementale des différents segments de l'a. poplitée permet de mieux comprendre la physiopathologie des traumatismes et des malpositions de l'axe artériel poplité.

     

High and low lateral approaches to the popliteal artery

Using a series of 20 dissections and two anatomic transverse sections of a lower limb, the authors investigated the lateral approaches to the popliteal artery. The high lateral approach (above the knee) is not very aggressive and gives access to the retro-genicular part of the popliteal artery. After cutaneous and fascial incision, a simple gap between the vastus lateralis and biceps femoris mm. allows easy exposure of the popliteal vessels after backward retraction of the sciatic nerve. The low lateral approach to the artery (below the knee) is very aggressive for the vessels, nerves, and ligaments of the area. It involves the resection of the upper fourth of the fibula and the isolation and protection of the common peroneal nerve Nevertheless, these lateral approaches must be known and used when classic approaches (medial and posterior) are impossible.     

闭合性腘动静脉损伤2例治疗分析

目的 探讨闭合性胭动静脉钝性损伤的诊治方法。方法 本院近期收治闭合性胭动静脉钝性损伤2例，两例患者均有膝关节周围骨折，脑动静脉均系钝性损伤。结合受伤情况及临床检查以及多普勒超声检查，早期诊断，早期仔细修复损伤的血管，术中、术后抗凝治疗，以及术中预防性筋膜切开减压、预防感染等综合治疗。结果 1例截肢，1例发生缺血性肌坏死虽保住了肢体，但遗留有严重的肢体功能障碍。结论 闭合性胭动静脉钝性损伤应早期诊断，积极采取手术等综合治疗，降低并发症发生率和截肢率。     

Branching patterns of the popliteal artery and its clinical importance

Purpose  The aim of this study was to evaluate the popliteal artery branching patterns and related measurements. Methods  A cadaveric study in forty lower limbs was performed to improve the understanding of anatomy of the popliteal artery and its main branches. Results  Normal branching of the popliteal artery was present in 36 specimens (90%). High origin of the anterior tibial artery was seen in two specimens (5%). The bifurcation was at the level of proximal border of popliteus, but the posterior tibial artery originated directly from the popliteal artery in one specimen (2.5%). Trifurcation pattern with no trunk was observed in one specimen (2.5%). Conclusions  We believe that a review of the anatomic characteristics of the popliteal artery and its branches will be beneficial for the surgical approaches and the choice of suitable arterial graft sites. This study was presented at 9th Congress of European Association of Clinical Anatomy in Prague, 5–8 September 2007.     

不同平面腘动脉损伤血清肌酸激酶动态变化的临床特点

目的　 探讨不同平面腘动脉损伤致患肢创伤严重程度的临床意义,评估腓肠动脉在腘动脉创伤修复中的作用。 方法　收集2010年1月~2019年12月收治的单侧膝关节周围骨折（含脱位）患者103例。其中,合并腘动脉损伤患者68例,根据损伤平面是否高于腓肠动脉分为高位组（16例）和低位组（52例）;其余35例为对照组。对比分析3组患者术前、术后1、3、7、15 d肌酸激酶（creatine kinase,CK）。 结果　高位组CK值显著大于低位组,低位组大于对照组（F=217.709,P<0.001）;同一时间点（术前、术后1、3、7、15 d）3组患者CK值两两比较均有明显差异（P<0.001)。高位组CK各时间点比较均有统计学差异（P<0.05）;低位组术前与术后7 d（P=0.930）、术后1 d与术后3 d（P=0.195）比较无统计学差异。 结论　高位组患肢缺血、损伤程度重于低位组;腓肠动脉是腘动脉不同损伤平面CK差异的主要原因,具有代偿作用。     

血管内支架植入术治疗左肾静脉压迫综合征的疗效

目的 观察血管内支架植入术治疗左肾静脉压迫综合征的临床疗效.方法 2002年6月至2011年7月本院本科采用血管内支架植入术治疗6例左肾静脉压迫综合征患者.患者术前、后进行了尿常规分析等实验室检查、彩色多普勒超声检查和(或)计算机断层扫描(CT)检查.结果 6例患者都成功植入了自膨式支架.术前和术后左肾静脉受压狭窄段的直径分别为(1.88±0.95)mm、(5.24±0.61) mm,差异有统计学意义(P＜0.05).术中左肾静脉测压为(11.00±4.34) mm Hg(1 mm Hg=0.133kPa),植入支架后为(6.00±2.55) mmHg,差异有统计学意义(P＜0.05).患者术后2～6个月肉眼或镜下观察血尿消失,尿液常规分析结果正常.术后随访6～60个月,肉眼或镜下观察患者血尿无复发;彩色多普勒超声或CT检查显示支架血流通畅,无再狭窄或血栓形成;2例左精索静脉曲张的患者完全缓解.结论 血管内支架植入术治疗左肾静脉压迫综合征有满意的临床疗效.     

Fascial entrapment neuropathy

Entrapment neuropathies are debilitating clinical conditions, creating significant morbidity in the upper and lower extremities in terms of pain, sensory abnormalities, and motor weakness, becoming a challenge to diagnose and treat. Because entrapments can have multiple origins, a misinterpretation of anatomy during examination can lead to incorrect diagnosis and treatment. This review addresses understanding of the anatomy of fascia that can play an important role in this syndrome. There is a specific microenvironment around the nerve composed of connective tissues that include deep fascia, intermuscular septa, epineurium, and perineurium. The microenvironmental modifications can be translated into change in mobility with consequence decreasing of the independency of the nerve from the surrounding structures lading to entrapments and “internal stretch lesion.” The entrapments reported in this article reinforce the importance of fascia tissue in generating common symptoms that pose more difficult diagnostic challenges and may often be confused with more common clinical conditions. Clin. Anat. 32:883–890, 2019. © 2019 Wiley Periodicals, Inc.     

Nerve entrapment syndromes in musicians

Nerve entrapment syndromes are common in instrumental musicians. Carpal tunnel syndrome, ulnar neuropathy at the elbow, and thoracic outlet syndrome appear to be the most common. While electrodiagnostic studies may confirm the diagnosis of nerve entrapment, they may be falsely normal in musicians. Non‐operative treatment with instrument and technique modification may help. Involvement with the musician's teacher to implement appropriate treatment is recommended. Outcomes for both non‐operative and operative treatment for various nerve entrapment syndromes have yielded mostly good to excellent results, similar to the general population. Clin. Anat. 27:861–865, 2014. © 2014 Wiley Periodicals, Inc.     

Anatomical basis for celiac trunk and superior mesenteric artery entrapment

Forty-six cadaveric specimens were dissected in order to study the anatomical relations between the median arcuate ligament (MAL), the celiac ganglion, and the origin of both the celiac and superior mesenteric arteries. We found that in 40 cases (87.5%) both vessels were held together by the ganglionic mass, and in 90.6%, the celiac trunk was covered, either partially or completely, by the MAL. These data indicated that this is a normal occurrence. In 10% of the cases both vessels were covered by the MAL. These anatomical findings may possibly contribute to the understanding of the socalled “median arcuate ligament syndrome.”     

隐神经卡压症的应用解剖学

本文在40侧成人下肢标本上观察了隐神经及其髌下支穿Hunter’s管前壁的形式及位置,并以腹股沟韬带中点至股骨内上髁最突出点的连线为标准,测量了缝匠肌前缘距该线以及隐神经穿出点距连线远端的距离。为探讨隐神经卡压症的病因、症状及选用的治方方法提供了应用解剖学基础。     

闭合性胫骨平台骨折合并腘动脉损伤的手术疗效分析

目的探讨闭合性胫骨平台骨折合并腘动脉损伤的手术疗效。方法回顾分析2005年1月~2014年12月收治且获得随访的68例闭合性胫骨平台骨折合并腘动脉损伤患者资料,男52例,女16例,胫骨平台骨折按Schatzker分型:Ⅳ型13例,V型32例,Ⅵ型23例。腘动脉损伤程度分级:完全断裂10例,部分断裂36例,外膜完整内膜损伤22例。受伤至手术时机:受伤6小时以内实施手术49例,受伤6~24小时实施手术11例,受伤48~96小时实施手术8例。末次随访根据Rasmussen膝关节功能评分标准进行评价。结果 49例6小时以内行血管探查修复并骨折复位固定的患者中,38例血液循环稳定,8例出现迟发性肌肉坏死,经多次清创,创面愈合,3例出现静脉危象,保肢无效。19例6小时以后实施手术的患者中,5例血液循环稳定,5例小腿肌肉部分坏死,经清创、换药、二期植皮后创面愈合;9例术后36~48小时出现血循环障碍,经急诊探查,其中1例患者好转,其余8例患者术后循环未改善,后出现大量肌肉坏死高热、肾衰,最后行高位截肢。根据Rasmussen膝关节功能评价标准:优20例,良26例,可9例,差13例,优良率67.6%。按照膝关节功能评分,手术时机、固定方式以及是否预防减压均有统计学意义。结论闭合性胫骨平台骨折伴腘动脉损伤患者早期诊断并在6小时内实施手术是保肢成功的关键,外固定架固定及预防性小腿筋膜室切开减压可减少肌肉坏死和感染的发生,降低并发症,改善预后。     

Left main renal artery entrapment by diaphragmatic crura: spiral CT angiography

Entrapment of renal artery by the diaphragmatic crus is a rare cause of renal artery stenosis. Spiral computed tomography angiography provides a definitive diagnosis and shows the precise relationship of the artery to the diaphragmatic crus. The authors present a case of hypertension developing in a young 20-year-old female due to entrapment of the left renal artery by the diaphragmatic crus. This condition should be considered in young hypertensive patients with renal artery stenosis without cardiovascular risk factors.