title: Anatomic and Ultrasonic Study Based on Selective Tibial Neurotomy.
abstract: BACKGROUND
  Selective tibial neurotomy (STN) was considered as an effective procedure for the treatment of spastic feet. It is also widely used for treating obese calves in some Asian countries. This study aimed to provide morphologic measurement data and theoretical support for the operation and intraoperative localization.
  
  
  METHODS
  Fifty lower legs from 20 embalmed cadavers and 5 fresh corpses were dissected to observe and record the relationship of 4 branches of the tibial nerve, as well as the length, width, and thickness of the triceps surae. An ultrasonic transducer was also used to measure the thickness of muscles of 50 volunteers and acquire the ultrasonic image of muscles and nerve branches.
  
  
  RESULTS
  Anatomic results showed that the tibial nerve gave off 4 branches in a proximal to distal direction: the medial sural cutaneous nerve, the motor branches innervating the medial and lateral gastrocnemius, and the motor branch innervating the soleus. These nerve branches had 8 patterns of origin. A significant finding was that the nerve innervating the soleus consisted of 2 branches. Ultrasonic measurement results showed that the thickness of the gastrocnemius and the soleus were positively related to the circumference of the calf.
  
  
  CONCLUSIONS
  The calf circumference was positively related to the thickness of the soleus and the gastrocnemius. Diverging patterns of tibial nerve branches were multiple, and caution should be used to prevent damaging other branches. Tibial nerve, branches, and diverging sites could be seen clearly in the ultrasonic image. A preoperational ultrasonic examination is recommended.
authors.affiliation: Department of Neurosurgery, Jilin University First Hospital, Changchun, China; Clinical College, Jilin University, Changchun, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Zhong
authors.affiliation: Department of Neurosurgery, Jilin University First Hospital, Changchun, China; Clinical College, Jilin University, Changchun, China.
authors.forename: Guihong
authors.initials: G
authors.lastname: Li
authors.affiliation: Public Health College, Jilin University, Changchun, China.
authors.forename: Liu
authors.initials: L
authors.lastname: Yang
authors.affiliation: Basic Medical College, Qiqihar Medical University, Qiqihar, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Yan
authors.affiliation: Department of Hand and Foot Surgery, Jilin University Second Hospital, Changchun, China.
authors.forename: Yufa
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Jilin University First Hospital, Changchun, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Zhao
authors.affiliation: Department of Human Anatomy, Jilin University, Changchun, China. Electronic address: 984919058@qq.com.
authors.forename: Youqiong
authors.initials: Y
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks / Q000000981:diagnostic imaging*; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging* / Q000294:innervation*; D019635:Neurosurgical Procedures / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013979:Tibial Nerve / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000601:surgery*
keywords: Anatomy; Calf reduction; Gastrocnemius; Selective neurotomy; Soleus; Spastic feet