Name: an anatomical study of nerves at risk during minimally invasive hallux valgus surgery
Uploaded: 2018-02-17T13:00:00
Description: Watch this Scientific Journal Video about An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery at JoVE.com

我们感谢巴塞罗那大学 Bellvitge 校园解剖室的技术人员, 他们提供了娴熟的帮助。我们感谢视听部门的工作与视频作为本出版物的一部分。我们感谢巴塞罗那大学医学系的捐赠者。

这项研究获得了机构伦理委员会 (Comissió de Bioètica) 的批准。解剖程序是由一个经验丰富的解剖学家进行的, 专门训练的平面解剖技术。这是确保实验结果成功的必要条件。
1. 准备
<ol><li>选择要包括在研究中的标本。使用膝下的尸体新鲜冰冻的人的脚。<ol>
<li>排除以下情况: 腿部、脚踝或脚部的任何畸形 (因为这可能影响神经的过程, 最终影响研究结果)、溃疡、疤痕或先前手?...

<ol>
	<li>Perera, A. M., Mason, L., Stephens, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+pathogenesis+of+hallux+valgus.">The pathogenesis of hallux valgus.</a> J Bone Joint Surg. 93 (17), 1650-1661 (2011).</li><li>Lucas, Y., Hernandez, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+moderate+hallux+valgus+by+percutaneous,+extra-articular+reverse-L+Chevron+(PERC)+osteotomy.">Treatment of moderate hallux valgus by percutaneous, extra-articular reverse-L Chevron (PERC) osteotomy.</a> Bone Joint J. 98B (3), 365-373 (2016).</li><li>Malagelada, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Increasing+the+safety+of+minimally+invasive+hallux+surgery-An+anatomical+study+introducing+the+clock+method.">Increasing the safety of minimally invasive hallux surgery-An anatomical study introducing the clock method.</a> Foot Ankle Surg. , 10-14 (2016).</li><li>Golan&#243;, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anatomy+of+the+ankle+ligaments:+A+pictorial+essay.">Anatomy of the ankle ligaments: A pictorial essay.</a> Knee Surg Sports Traumatol Arthrosc. 18 (5), 557-569 (2010).</li><li>Dalmau-Pastor, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Extensor+apparatus+of+the+lesser+toes:+anatomy+with+clinical+implications--topical+review.">Extensor apparatus of the lesser toes: anatomy with clinical implications--topical review.</a> Foot Ankle Int. 35 (10), 957-969 (2014).</li><li>Dalmau-Pastor, M., Yasui, Y., Calder, J. D., Karlsson, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anatomy+of+the+inferior+extensor+retinaculum+and+its+role+in+lateral+ankle+ligament+reconstruction+a+pictorial+essay.">Anatomy of the inferior extensor retinaculum and its role in lateral ankle ligament reconstruction a pictorial essay.</a> Knee Surg Sports Traumatol Arthrosc. 24 (4), 957-962 (2016).</li><li>Vesalius, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> De humanis corporis fabrica libris septem. , (1543).</li><li>Dalmau-Pastor, M., Vega, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Letter+Regarding+Cadaveric+Analysis+of+the+Distal+Tibiofibular+Syndesmosis.">Letter Regarding Cadaveric Analysis of the Distal Tibiofibular Syndesmosis.</a> Foot Ankle Int. 38 (3), 343-345 (2017).</li><li>Caraballo, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Vascular+Structures+of+the+Lateral+Wall+of+the+Maxillary+Sinus:+A+Vascular+Labeling+Technique.">Vascular Structures of the Lateral Wall of the Maxillary Sinus: A Vascular Labeling Technique.</a> Implant Dent. 26 (1), 153-157 (2017).</li><li>Golan&#243;, P., Vega, J., P&#233;rez-Carro, L., G&#246;tzens, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ankle+Anatomy+for+the+Arthroscopist.+Part+I:+The+Portals.">Ankle Anatomy for the Arthroscopist. Part I: The Portals.</a> Foot Ankle Clin. 11 (2), 253-273 (2006).</li><li>Golan&#243;, P., Vega, J., P&#233;rez-Carro, L., G&#246;tzens, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ankle+Anatomy+for+the+Arthroscopist.+Part+II:+Role+of+the+Ankle+Ligaments+in+Soft+Tissue+Impingement.">Ankle Anatomy for the Arthroscopist. Part II: Role of the Ankle Ligaments in Soft Tissue Impingement.</a> Foot Ankle Clin. 11 (2), 275-296 (2006).</li></ol>

本研究所用方法的基础是断层解剖和解剖平面解剖的结合, 因为它在历史上已经被实践了7。这不仅要求解剖学知识, 而且需要具体的训练, 什么是时间苛刻的技术, 极大地依赖于刀的技能。因此, 解剖学教科书或科学论文中提供的一些解剖学图像, 特别是在骨科手术领域, 缺乏准确性, 对外科医生执行尖端技术没有足够的指导意义, 比如微创程序。因此, 文献中建议, 应在专家、外科?...

拇外翻是一种常见的病理影响第一趾, 其中近方阵是横向偏离, 而第一跖骨是偏离内侧1。经皮穿刺或微创手术 (MIS) 技术的拇外翻是这一学科的第一个描述, 许多研究报告他们的好处, 但也有其风险2。拇外翻错误矫正涉及截骨术通过小切口使用特定的手术器械进行。鉴于未进行开放性解剖, 神经血管结构损伤的风险高于开放手术时的识别。此外, 与任何外科手术一样, 病人和外科医生在手术台周围的定位远不像经典解剖书籍或论文中描述的解剖位置。
拇外翻手术危险的神经结构是大脚趾的背内侧神经, 腓浅神经的分支, 大脚趾的侧神经, 腓深神经的分支。本研究的目的是描述这些神经的位置, 对于拇趾手术切口使用, 并说明了一种新的方法, 容易重现的手术条件。此外, 还介绍了使用经皮器械的安全门户。
在任何外科领域, 特别是在微创过程中, 全面的解剖学知识是必不可少的。新的外科和影像学技术的发展需要对解剖地标的二维和三维定位有新的认识。以前报告的解剖解剖技术是由我们的团队开发的, 以克服传统解剖技术的局限性3,4,5,6和这里被应用于重现与治疗拇外翻 (高压) 和层 (HR) 病理的 MIS 程序相对应的皮肤切口和仪表入口入口。因此, 该方法适用于从传统的开放式手术到 MIS3,4,5,6的外科技术。

<table border="0" cellpadding="0" cellspacing="0" width="955">
	<tbody>
		<tr height="40">
			<td height="40" style="height:40px;width:240px;">Adson Non-Toothed dissection forceps</td>
			<td style="width:204px;">Bontempi</td>
			<td style="width:344px;">BD-31</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:240px;">Adson Toothed dissection forceps</td>
			<td style="width:204px;">Bontempi</td>
			<td style="width:344px;">BD-30</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:240px;">Surgical scalpel handle n&#186; 4</td>
			<td style="width:204px;">Swann-Morton</td>
			<td style="width:344px;">4</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:240px;">Surgical scalpel blades n&#186; 24</td>
			<td style="width:204px;">Swann-Morton</td>
			<td style="width:344px;">24</td>
			<td style="width:167px;">Ad libitum</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:240px;">Iris scissors- curved</td>
			<td style="width:204px;">Bontempi</td>
			<td style="width:344px;">FG-2</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:240px;">Periostotome P-24</td>
			<td style="width:204px;">Bontempi</td>
			<td style="width:344px;">718-24G</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:240px;">Intramuscular 23G sterile needles</td>
			<td style="width:204px;">Totclinic</td>
			<td style="width:344px;">23</td>
			<td style="width:167px;">Ad libitum</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:240px;">Goniometer</td>
			<td></td>
			<td></td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:240px;">Latex gloves</td>
			<td></td>
			<td></td>
			<td style="width:167px;">Ad libitum</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:240px;">Gauze pads</td>
			<td></td>
			<td></td>
			<td style="width:167px;">Ad libitum</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:240px;">Non-Sterile surgical drape</td>
			<td></td>
			<td></td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:240px;">Saw</td>
			<td>EXAKT Advanced Technologies GmbH</td>
			<td>EXAKT 312 Pathology Saw</td>
			<td></td>
		</tr>
	</tbody>
</table>

an anatomical study of nerves at risk during minimally invasive hallux valgus surgery

微创外科 (MIS) 程序的日益普及, 使得有必要新的解剖学参考, 以帮助在立体定位和定位的结构, 不直接可见的外科医生。这对于像神经或血管这样危险的结构尤为重要。最优化的尸体处理材料和多种技术的结合, 以弥补有限的可用性标本。该协议结合解剖平面解剖和新鲜冷冻标本的断层解剖, 帮助本地化相关结构, 如神经, 动脉, 静脉和正确定位的门户在 MIS 程序。解剖教科书中对这些结构的描述与手术领域所遇到的不同;由于这个原因, 需要新的解剖学研究与外科的方向。然而, 这是一个复杂的, 耗时的技术, 需要具体的培训。用所谓的 "时钟方法" 描述的解剖学参考资料为外科医生提供了一个简单而又可重复的系统, 用于在拇外翻 MIS 程序中找到危险神经的路径。该模型可推断为许多其他微创手术程序。

使用时钟方法, 背内侧和侧神经一直被发现在10和2点之间 (图1)。背内侧神经被发现在平均26.2°内侧在弹流润滑的内侧边界, 对应于一个区域在12和2点之间在右脚, 并且在10和12点之间在左脚。侧神经是32.3°侧向内侧边界的弹润滑平均, 这相当于一个区域之间的12和2点左脚, 并在10和12点之间的右脚。
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Watch this Scientific Journal Video about An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery at JoVE.com

An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery

微创拇外翻手术中神经风险的解剖学研究

微创外科 (MIS) 程序依赖于解剖学上的参考, 以定位结构不直接可见的外科医生。本手稿描述了一种联合的方法, 平面解剖和切片解剖的新鲜冰冻标本, 以确定风险结构在 MIS 程序。

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