Возможности ультразвукового исследования в диагностике диабетической периферической полинейропатии нижних конечностей у детей 5-17 лет

2019 ◽  
pp. 64-86
Keyword(s):  
Diabetes Mellitus ◽  
Sciatic Nerve ◽  
Peripheral Nerves ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Lower Extremities ◽  
Common Peroneal Nerve ◽  
Nerve Ultrasound

Билатерально исследованы 840 периферических нервов нижних конечностей (седалищные, большеберцовые и общие малоберцовые нервы). Контрольную группу составили 480 нервных стволов 80 здоровых детей в возрасте от 5 до 17 лет, основную - 360 нервных стволов 60 детей, страдающих сахарным диабетом 1-го типа, в возрасте от 5 до 17 лет. Всем пациентам основной группы проведена электронейромиография. Основная группа разделена на две подгруппы: в подгруппу А вошли 126 нервных стволов 21 ребенка в возрасте от 5 до 17 лет с нормальными показателями электронейромиографии периферических нервов нижних конечностей; в подгруппу Б - 234 нервных ствола 39 детей в возрасте от 8 до 17 лет, у которых при электронейромиографии выявлены нарушения невральной проводимости отдельных нервов. Для оценки размеров нервов дополнительно проведено внутригрупповое разделение на 4 возрастные категории (5-7 лет, 8-10 лет, 11-13 лет, 14-17 лет). Всем паци ентам выполнено ультразвуковое иссле дование нервов нижних конечностей на аппарате DC-8 (Mindray, Китай) широкополосными линейными датчиками с диапазоном частот 3-12 и 6-14 МГц. Оценке подвергались следующие параметры: площадь поперечного сечения нерва (при поперечном сканировании), его эхоструктура и контуры (при продольном сканировании) (для каждого нерва на двух уровнях). Площадь поперечного сечения седалищного нерва при сахарном диабете 1-го типа у детей старше 11 лет достоверно больше (P 0,05) по сравнению с контрольной группой. Достоверные различия (P 0,05) по площади поперечного сечения седалищного нерва между подгруппами А и Б определялись только на проксимальном уровне и только у детей старше 14 лет. Площадь поперечного сечения большеберцового нерва при сахарном диабете 1-го типа у детей старше 11 лет достоверно больше (P 0,05) по сравнению с контрольной группой. Тест “отсутствие чере дования линейных структур пониженной и повышенной эхогенности (однородная эхоструктура на фоне пониженной эхогенности или практически однородная эхоструктура на фоне повышенной эхогенности и едва различимых линейных гипоэхогенных структур) большеберцового нерва - диабетическая периферическая нейропатия” у детей с сахарным диабетом 1-го типа характеризовался чувствительностью 71,8%, специфичностью 100,0%, AUC 0,859. Тест “практически однородная эхоструктура на фоне повышенной эхогенности и едва различимых линейных гипоэхогенных структур большеберцового нерва - диабетическая периферическая нейропатия” у детей с сахарным диабетом 1-го типа характеризовался чувствительностью 66,7%, специфичностью 100,0%, AUC 0,833. Достоверные различия между степенями компенсации сахарного диабета 1-го типа при оценке эхоструктуры седалищного и большеберцового нервов определяются только в подгруппе Б (P = 0,000 для обоих сравнений). Получена достоверная (P 0,05) положительная корреляция между значениями площади поперечного сечения исследованных нервов на всех уровнях измерения и возрастом паци ентов в контрольной (rS - 0,54-0,90) и основной (rS - 0,17-0,62) группах и между значениями площади поперечного сечения исследованных нервов на всех уровнях измерения и стажем сахарного диабета 1-го типа в основной группе (rS - 0,40-0,57). Ультразвуковое исследование периферических нервов нижних конечностей может быть использовано в диагностике диабетической периферической нейропатии у детей с сахарным диабетом 1-го типа. Ключевые слова: ультразвуковое исследование нервов, сахарный диабет, диабетическая дистальная полинейропатия, периферические нервы, седалищный нерв, большеберцовый нерв, общий малоберцовый нерв, нижние конечности, дети, nerve ultrasound, diabetes mellitus, diabetic distal polyneuropathy, peripheral nerves, sciatic nerve, tibial nerve, common peroneal nerve, lower extremities, children

scholarly journals The level of the sciatic nerve division and its relations to the piriform muscle

2005 ◽  
Vol 62 (1) ◽  
pp. 45-49 ◽  
Author(s):  
Sladjana Ugrenovic ◽  
Ivan Jovanovic ◽  
Vladislav Krstic ◽  
Vesna Stojanovic ◽  
Ljiljana Vasovic ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Lower Extremities ◽  
Common Peroneal Nerve ◽  
Popliteal Fossa ◽  
Terminal Branch ◽  
Sacral Plexus ◽  
The Common ◽  
Popliteal Block

Background. The sciatic nerve, as the terminal branch of the sacral plexus, leaves the pelvis through the greater sciatic foramen beneath the piriform muscle. Afterwards, it separates into the tibial and the common peroneal nerve, most frequently at the level of the upper angle of the popliteal fossa. Higher level of the sciatic nerve division is a relatively frequent phenomenom and it may be the cause of an incomplete block of the sciatic nerve during the popliteal block anesthesia. There is a possibility of different anatomic relations between the sciatic nerve or its terminal branches and the piriform muscle (piriformis syndrome). The aim of this research was to investigate the level of the sciatic nerve division and its relations to the piriform muscle. It was performed on 100 human fetuses (200 lower extremities) which were in various gestational periods and of various sex, using microdissection method. Characteristic cases were photographed. Results. Sciatic nerve separated into the tibial and common peroneal nerve in popliteal fossa in 72.5% of the cases (bilaterally in the 66% of the cases). In the remainder of the cases the sciatic nerve division was high (27.5% of the cases) in the posteror femoral or in the gluteal region. Sciatic nerve left the pelvis through the infrapiriform foramen in 192 lower extremities (96% of the cases), while in 8 lower extremities (4% of the cases) the variable relations between sciatic nerve and piriform muscle were detected. The common peroneal nerve penetrated the piriform muscle and left the pelvis in 5 lower extremities (2.5% of the cases) and the tibial nerve in those cases left the pelvis through the infrapiriform foramen. In 3 lower extremities (1.5% of the cases) common peroneal nerve left the pelvis through suprapiriform, and the tibial nerve through the infrapiriform foramen. The high terminal division of sciatic nerve (detected in 1/3 of the cases), must be kept in mind during the performing of popliteal block anesthesia. Conclusion. Although very rare, anatomical abnormalities of common peroneal nerve in regard to piriform muscle are still possible.

scholarly journals VARIANT RELATION OF THE SCIATIC NERVE TO THE PIRIFORMIS MUSCLE: A CADAVERIC STUDY FROM NORTH INDIA. Variaciones en la relación del nervio ciático con el músculo piriforme: Un estudio cadavérico en India del Norte

2016 ◽  
Vol 8 (1) ◽  
pp. 38-42
Author(s):  
Virendra Budhiraja ◽  
Rakhi Rastogi ◽  
Sanjeev K Jain ◽  
Nidhi Sharma ◽  
Rohin Garg ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Clinical Outcomes ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Common Peroneal Nerve ◽  
North India ◽  
Piriformis Muscle ◽  
The Common ◽  
Long Course ◽  
Relationship Of

El nervio ciático sale de la pelvis y entra en la  región glútea debajo del  músculo piriforme como un único tronco. Tiene dos componentes: el nervio peroneo común y el  nervio tibial. La relación variable del nervio ciático con el músculo piriforme y su longitud hace que el nervio sea vulnerable a las lesiones. Estudiamos la relación variable del nervio ciático en sesenta extremidades inferiores de treinta cadáveres y encontramos el nervio ciático emergiendo indiviso por debajo del músculo piriforme en el 68,33% de los casos, pero en el 31,66% el nervio ciático estaba dividido arriba en la pelvis. En el 18,33% de los casos el componente peroneo común emergió arriba y en el 13,33% de los casos emergió a través del  músculo piriforme. Pensamos que tener un conocimiento adecuado sobre la anatomía del  nervio ciático es bueno para los resultados clínicos.  Sciatic nerve leaves the pelvis and enters the gluteal region below the piriformis muscle as single trunk. It has two components common peroneal nerve and the tibial nerve. The variable relationship of sciatic nerve with the piriformis muscle and its long course makes the nerve vulnerable to injury. We studied sciatic nerve variable relation in sixty lower extremities of thirty cadavers and found the sciatic nerve emerging undivided below the piriformis muscle in 68.33% of cases but in 31.66% the sciatic nerve divided high in the pelvis. In 18.33% cases the common peroneal component emerged above and in 13.33% of cases it emerged through the piriformis muscle. We think proper knowledge of the anatomy of the sciatic nerve is good for clinical outcomes

scholarly journals Unilateral higher division of sciatic nerve and its clinical importance

2019 ◽  
Vol 8 (1) ◽  
pp. 355
Author(s):  
Sonia Jandial
Keyword(s):  
Sciatic Nerve ◽  
Coming Out ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Clinical Importance ◽  
Common Peroneal Nerve ◽  
Gluteal Region ◽  
Piriformis Muscle ◽  
Long Course ◽  
The Right

The sciatic nerve has a long course right from the pelvis to the apex of the popliteal fossa. The point of division of the sciatic nerve into tibial and common peroneal nerves is very variable. The variation in the division of the sciatic nerve described in the present study should be helpful for anaesthetists and orthopaedic surgeons. While doing the dissection and teaching of the gluteal region in the Post Graduate Department of Anatomy, government medical college, Jammu, it was found that on the left side tibial nerve and common peroneal nerve were present instead of sciatic nerve. It meant that the main nerve that is the sciatic nerve had already been divided into its terminal branches in the pelvis region. Both tibial and common peroneal nerve were seen coming out of the pelvis below the piriformis muscle, while on the right side there were no variation. The sciatic nerve was seen coming out of the pelvis below the piriformis muscle as usual. Because of this high division of the sciatic nerve in the pelvis, there are many complications like failed sciatic nerve block during anaesthesia while performing surgery, but high division of the sciatic nerve may result in escape of either tibial nerve or common peroneal nerve. The gluteal region, back of the thigh and leg of the lower limb were dissected to study further course of tibial nerve and the common peroneal nerve. Photographs were also taken.

scholarly journals The anatomic location and importance of the tibialis posterior fascicular bundle at the sciatic nerve bifurcation: report of 3 cases

2019 ◽  
Vol 131 (6) ◽  
pp. 1869-1875 ◽  
Author(s):  
Thomas J. Wilson ◽  
Andres A. Maldonado ◽  
Kimberly K. Amrami ◽  
Katrina N. Glazebrook ◽  
Michael R. Moynagh ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Common Peroneal Nerve ◽  
Foot Drop ◽  
Preoperative Imaging ◽  
Tibialis Posterior ◽  
Severe Injuries ◽  
Nerve Action ◽  
Internal Neurolysis

The authors present the cases of 3 patients with severe injuries affecting the peroneal nerve combined with loss of tibialis posterior function (inversion) despite preservation of other tibial nerve function. Loss of tibialis posterior function is problematic, since transfer of the tibialis posterior tendon is arguably the best reconstructive option for foot drop, when available. Analysis of preoperative imaging studies correlated with operative findings and showed that the injuries, while predominantly to the common peroneal nerve, also affected the lateral portion of the tibial nerve/division near the sciatic nerve bifurcation. Sunderland’s fascicular topographic maps demonstrate the localization of the fascicular bundle subserving the tibialis posterior to the area that corresponds to the injury. This has clinical significance in predicting injury patterns and potentially for treatment of these injuries. The lateral fibers of the tibial division/nerve may be vulnerable with long stretch injuries. Due to the importance of tibialis posterior function, it may be important to perform internal neurolysis of the tibial division/nerve in order to facilitate nerve action potential testing of these fascicles, ultimately performing split nerve graft repair when nerve action potentials are absent in this important portion of the tibial nerve.

scholarly journals Common Peroneal Nerve Grafting to Repair the Tibial Nerve as a Salvage Procedure in the Treatment of Sciatic Nerve Injury with Long-Segment Defects

2018 ◽  
Vol 03 (01) ◽  
pp. e41-e45
Author(s):  
Haodong Lin ◽  
Desong Chen ◽  
Chunlin Hou
Keyword(s):  
Sciatic Nerve ◽  
Nerve Injury ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Plantar Flexion ◽  
Common Peroneal Nerve ◽  
Sciatic Nerve Injury ◽  
Salvage Procedure ◽  
Nerve Grafting ◽  
The Common

Background In sciatic nerve neuropathies, when direct nerve repair is impossible due to a large gap, nerve grafting can be performed. However, the diameters of traditional autologous nerve grafts are too small to cover the whole cross-sectional area of the sciatic nerve. The aim of this study is to present the outcome of common peroneal nerve grafting to repair the tibial nerve in eight patients with sciatic nerve injuries, showing long defects of more than 10 cm. Methods Between 2007 and 2013, the common peroneal nerve was used as an autograft to repair the tibial nerve in eight patients with complete high sciatic nerve injury with long defects. There were 6 men and 2 women with an average age of 31 years (range: 17–44 years). Muscle strength was evaluated using the British Medical Research Council scale. The Semmes–Weinstein monofilament test was used for sensory evaluation. Results The follow-up time for patients ranged from 36 to 60 months, with an average of 48.75 months. Tibial nerve motor function was “good” or “very good” (M3–M4) in five out of eight patients (55.6%). Plantar flexion was not adequate in the rest of the patients. Sensory recovery was “good” or “very good” (S2–S3) in six patients and “inadequate” (S4) in two patients. Conclusion In cases where there were extensive gaps in the sciatic nerve, using the common peroneal nerve as an autograft to repair the tibial nerve provides an alternative to traditional nerve graft repair.

scholarly journals Bilateral eventration of sciatic nerve

2010 ◽  
Vol 50 (180) ◽  
Author(s):  
T Sharma ◽  
RK Singla ◽  
M Lalit
Keyword(s):  
Sciatic Nerve ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Common Peroneal Nerve ◽  
Leg Pain ◽  
Piriformis Syndrome ◽  
Piriformis Muscle ◽  
Male Cadaver ◽  
The Common ◽  
Popliteal Block

During routine dissection of a 60 years male cadaver, it was observed that the two divisions of sciatic nerve were separate in the gluteal region on both the sides with the tibial nerve passing below the piriformis and the common peroneal nerve piercing the piriformis muscle. The abnormal passage of the sciatic nerve (SN), the common peroneal nerve (CPN), and the tibial nerve (TN), either through the piriformis or below the superior gemellus may facilitate compression of these nerves. Knowledge of such patterns is also important for surgeons dealing with piriformis syndrome which affects 5-6% of patients referred for the treatment of back and leg pain. A high division may also account for frequent failures reported with the popliteal block. Keywords: eventration, piriformis muscle, piriformis syndrome, sciatic nerve

A New Anterior Approach to the Sciatic Nerve Block 

1999 ◽  
Vol 91 (6) ◽  
pp. 1655-1655 ◽  
Author(s):  
Jacques E. Chelly ◽  
Laurent Delaunay
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Anterior Approach ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Common Peroneal Nerve ◽  
Sensory Block ◽  
Pubic Symphysis ◽  
Sciatic Nerve Block ◽  
Nerve Blocks

Background Although several anterior approaches to sciatic nerve block have been described, they are used infrequently. The authors describe a new anterior approach that allows access to the sciatic nerve with the patient in the supine position. Method Sciatic nerve blocks were performed in 22 patients. A line was drawn between the inferior border of the anterosuperior iliac spine and the superior angle of the pubic symphysis tubercle. Next, a perpendicular line bisecting the initial line was drawn and extended 8 cm caudad. The needle was inserted perpendicularly to the skin, and the sciatic nerve was identified at a depth of 10.5 cm (9.5-13.5 cm; median and range) using a nerve stimulator and a 15-cm b-beveled insulated needle. After appropriate localization, either 30 ml mepivacaine, 1.5% (group 1 = knee arthroscopy; n = 16), or 15 ml mepivacaine, 1.5%, plus 15 ml ropivacaine, 0.75%, (group 2 = other procedures; n = 6) was injected. Results Appropriate landmarks were determined within 1.3 min (0.5-2.0 min). The sciatic nerve was identified in all patients within 2.5 min (1.2-5 min), starting from the beginning of the appropriate landmark determination to the stimulation of its common peroneal nerve component in 13 cases and its tibial nerve component in 9 cases. A complete sensory block in the distribution of both the common peroneal nerve component and the tibial nerve component was obtained within 15 min (5-30 min). A shorter onset was observed in patients who received mepivacaine alone compared with those who received a mixture of mepivacaine plus ropivacaine (10 min [5-25 min] vs. 20 min [10-30 min]; P < 0.05). Recovery time was 4.6 h (2.5-5.5 h) after mepivacaine administration. The addition of ropivacaine produced a block of a much longer duration 13.8 h (5.2-23.6 h); P < 0.05. No complications were observed. Conclusions This approach represents an easy and reliable anterior technique for performing sciatic nerve blocks.

scholarly journals Cadaveric Study of the Mode of Termination of the Sciatic Nerve in a Malian Population: Cases of Trifurcation and Hexafurcation

2021 ◽  
Author(s):  
Tata Touré ◽  
Babou Ba ◽  
Adoul Kader Moussa ◽  
Abdoulaye Kanté ◽  
Falé Traoré ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Artery Aneurysm ◽  
Common Peroneal Nerve ◽  
Anatomical Variations ◽  
Popliteal Fossa ◽  
Terminal Branch ◽  
Cross Sectional ◽  
Significant Difference

Abstract Background: The sciatic nerve is the largest nerve in body. It is the only terminal branch of the sacral plexus. It emerges under the piriformis muscle, descends into the gluteal region, then into the posterior compartment of the thigh. It ends in the popliteal fossa by dividing into the tibial and common peroneal nerve. It is the most frequently injured nerve. The aim of this work was to study the mode of termination of the sciatic nerve by cadaveric dissection in a Malian population.Materials and methods: This was a cross-sectional study, carried out at the anatomy laboratory of the Faculty of Medicine and Odontostomatology of Bamako, ranging from December 2019 to April 2021. The sciatic nerve was dissected 74 times in 37 cadaveric subjects (29 men and 8 women).Results: The classic termination mode (the sciatic nerve terminates giving the tibial nerve and common peroneal nerve) was most frequently encountered with a prevalence of 82.43%. Anatomical variations were noted in 17.57%. Among these variations, trifurcation (termination in three branches) of the sciatic nerve was observed in 16.22%. Hexafurcation (six-branch termination) of the sciatic nerve was observed in 1.35%. The termination mode showed a significant difference being more frequently bilateral than unilateral (P˂0.05)Conclusion: Anatomical variations in the mode of termination of the sciatic nerve are not uncommon. The most common of these variations is the trifurcation in which the sciatic nerve ends up giving the tibial nerve, the common peroneal nerve and a third branch which is variable. Knowledge of these variations is important for surgeons when treating popliteal artery aneurysm, popliteal vessel fistula and popliteal fossa cysts.

scholarly journals The Anatomic Relationship of the Tibial Nerve to the Common Peroneal Nerve in the Popliteal Fossa: Implications for Selective Tibial Nerve Block in Total Knee Arthroplasty

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Eric R. Silverman ◽  
Amaresh Vydyanathan ◽  
Karina Gritsenko ◽  
Naum Shaparin ◽  
Nair Singh ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Sciatic Nerve ◽  
Nerve Block ◽  
Knee Arthroplasty ◽  
Local Anesthetic ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Common Peroneal Nerve ◽  
Ultrasound Guided ◽  
Total Knee

Background. A recently described selective tibial nerve block at the popliteal crease presents a viable alternative to sciatic nerve block for patients undergoing total knee arthroplasty. In this two-part investigation, we describe the effects of a tibial nerve block at the popliteal crease. Methods. In embalmed cadavers, after the ultrasound-guided dye injection the dissection revealed proximal spread of dye within the paraneural sheath. Consequentially, in the clinical study twenty patients scheduled for total knee arthroplasty received the ultrasound-guided selective tibial nerve block at the popliteal crease, which also resulted in proximal spread of local anesthetic. A sensorimotor exam was performed to monitor the effect on the peroneal nerve. Results. In the cadaver study, dye was observed to spread proximal in the paraneural sheath to reach the sciatic nerve. In the clinical observational study, local anesthetic was observed to spread a mean of 4.7+1.9 (SD) cm proximal to popliteal crease. A negative correlation was found between the excess spread of local anesthetic and bifurcation distance. Conclusions. There is significant proximal spread of local anesthetic following tibial nerve block at the popliteal crease with possibility of the undesirable motor blocks of the peroneal nerve.

scholarly journals COMBINED INTEROSSEOUS TIBIAL NERVE AND COMMON PERONEAL NERVE BLOCKS FOR FOOT SURGERY

1987 ◽  
Vol 67 (3) ◽  
pp. A288-A288
Author(s):  
S. M. Shulman ◽  
A. T. C. Peng ◽  
K. Nyunt ◽  
I. J. Kepes ◽  
L. S. Blancato
Keyword(s):  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Common Peroneal Nerve ◽  
Foot Surgery ◽  
Nerve Blocks
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