腓肠肌内侧头肌支神经切断小腿减肥术应用解剖及临床效果观察

目的介绍将腓肠肌内侧头肌支神经切断使之萎缩,改善小腿粗壮外形的方法。方法解剖20具尸体腿,观察、测量腓肠肌内侧头肌支神经,为手术提供解剖学基础。对16例腓肠肌内侧头肥大者行腓肠肌内侧头肌支神经切断小腿减肥术,测量并记录小腿周径和外形变化。结果腓肠肌内侧头肌支神经在窝处从胫神经发出,以独立1支走向肌门者占40%,中途分成2支者占30%,与腓肠内侧皮神经共干起始者占30%。以股骨内上髁水平线为基线,该肌支起点平均高度为(-6.6±13.7)mm,起始处宽度(2.3±0.4)mm,长度为(42±12)mm。16例术后小腿最大周径平均缩减(3.5±1.1)cm,内侧曲线平缓。术后早期可下地行走,无明显肿胀。随访半年,日常活动未受影响。结论腓肠肌内侧头肌支神经切断小腿减肥术简便、安全、效果明显,不影响受术者的行走功能。

The anatomic study and clinical observation of the neurectomy of the nerve to the medial gastrocnemius muscle for calf reduction

OBJECTIVE: To introduce a method to reduce the volume of medial gastrocnemius for calf reduction. METHODS: Tibial nerve and nerve branches were dissected and explored at popliteal region for morphometry in 20 cadaver-legs. The length, width and the origination position of the nerve to the medial gastrocnemius were measured and recorded. During surgery, the nerve to the medial gastrocnemius muscle were explored and cut off. The circumference and the shape of the leg were measured and recorded. RESULTS: The nerve innervating the medial gastrocnemius originates from the tibial nerve which lies in the fat tissue of popliteal space. In 8 cases (40%) there is only 1 branch to the medial gastrocnemius, and in 4 cases (30%) there are 2 branches. In other 4 cases (30%) the medial sural cutaneous nerve originate from the nerve to the medial gastrocnemius. The nerve to the medial gastrocnemius muscle branch off at (- 6.6 +/- 13.7) mm; the width is (2.3 +/- 0.4) mm; the length is (42 +/- 12) mm. Neurectomy of the nerve to the medial gastrocnemius was performed in 16 cases. After operation, the circumference of the leg was reduced (3.5 +/- 1.1) cm averagely and the curve of the medial line of the calf was reduced. There is no obvious swelling in these cases and the patients were able to walk immediately after operation. The function of the leg was not obviously influenced. CONCLUSIONS: Neurectomy of the nerve to the medial gastrocnemius muscle was a safe and effective method for calf reduction.