Anatomy Of Compression Of Common Peroneal Nerve And Experimental Study Of Regenerational Methods

【Objective】1. To explore whether the end-to-side neurorrhaphy can prevent denervated skeletal muscle from atrophy after having common peroneal nerve entrapment.2. To evaluate the feasibility of the end-to-side neurorrhaphy curing peroneal nerve injury and promoting the functional recovery of peroneal nerve. 3. To find the compression position of the peroneal myotube syndrome .【Methods】1. 64 Sprague-Dawley rats were randomly divided into two groups, 32 each. In group A, the left peroneal nerve was transected completely and established a model of tibial muscle without nerve controlling; Group B received the same nerve transaction,but the distal end was anastomosed to the tibial nerve in a end-to-side pattern (nerve baby-sitting), and the right sides in both groups were served as self control . In 2,4,6,8weeks after surgery, the function of peroneal nerve in moving and the muscle atrophy were observed, The fibrillation potential, reinnervation potential, wet weight, muscle fiber cross section area, and the activity of Na+-K+-ATPase of the peroneal nerve were measured。3 months later, the peroneal nerve was separated from the tibial nerve, and reanastomosed to its proximal end.after feeding 3 months, The function of the peroneal nerve and the degree of the tibial muscle atrophy were observed, the wet muscle weight,muscle fiber cross section area and the activity of Na+-K+-ATPase of the tibial muscle were measured. In the animal model, the hind limb are chose as experimental groups.2..18 dead body were used in this study.The S-shape incision starts from popliteal fossa to the lateral lower leg.The skin and subcutaneous tissue was separated carefully .Observe how long the Common Peroneal Nerve next to the periosteum was in the peroneal myotube,the character of peroneus longus fibrous arch, the distance from entrance and exit to fibular head,the Transverse diameter of Common Peroneal Nerve in the beginning of lateral groove and peroneal myotube part and position of bifurcate of Superficial Peroneal Nerve and The deep peraoneal nerve.【Results】1. In the nerve losting group, the wet muscle weight,muscle fiber cross section area and the enzymatic activity of Na+-K+-ATPase of the tibial muscle decreased significantly compared to the control group. And the end-to-side anastomosis group were detected after surgery while no such potential were found in control group.2. The recovery rate of the electrophysiology,the wet muscle weight,muscle fiber cross section area and the enzymatic activity of Na+-K+-ATPase of the tibial muscle in end-to-side anastomosis group were much higher than the control group, in 3 months after the end-to-side anastomosis surgery, and the functional recovery of peroneal nerve were better than the non end-to-side anastomosis group.3. Common Peroneal Nerve in fibular myotube is in arc shape, closely adhered to peroneal periosteum and has a length of 25.78±2.6mm ,and the distance between entrance to peroneal myotube is and fibular head is 13.9±1.9mm.Different types of the exit are as follows:Tendinous fibrous tissues occupies 13.3%;the muscle was of muscular origin in 8.5%and the mixed type78.2%.it has a distance of 35.1±2.8 mm from peroneal head.Lengths of common peroneal nerve travelling with the periosteum of the neck of fibula closely are 27.1±2.3mm.Thearc of muscle peroneuslongus constructed the vault of peroneal tunnel,and 7.6%of them are tendonous, 3.0%are muscle,and 89.4% are a mixture of both.The diameter of th former is 4.2±0.8(2.9~6.4)mm,and the later 6.4±0.4(4.8~6.4)mm. The diameter in bifurcate of Superficial Peroneal Nerve and the deep peraoneal nerve is 6.5±0.4mm .【Conclusions】1.The end-to-side neurorrhaphy can prevent denervated skeletal muscle from atrophy after having common peroneal nerve entrapment.2.It has the feasibility of the end-to-side neurorrhaphy curing peroneal nerve injury and promoting the functional recovery of peroneal nerve.3. The compression position of the peroneal myotube syndrome lie in the position of the bifurcate of Superficial Peroneal Nerve and the deep peraoneal nerve more riched in connective tissues , closely adherence to the periosteum and anatomy of dense of peroneal myotube.