坐骨神经的解剖走向与全髋关节置换术的不同方法有关。

IF 2 3区医学 Q2 ORTHOPEDICS International Orthopaedics Pub Date : 2024-10-01 Epub Date: 2024-08-26 DOI:10.1007/s00264-024-06281-7

Hannes Stofferin, Katharina Pfitscher, Romed Hörmann, Raphael Gmeiner, Martin Thaler

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引用次数: 0

摘要

目的：虽然坐骨神经（SN）损伤相对罕见，但它是初次和翻修全髋关节置换术（THA）后的一种破坏性并发症。因此，坐骨神经的精确定位对关节置换外科医生来说至关重要：方法：我们从福尔马林固定的尸体上解剖了 50 个半髋。方法：我们从福尔马林固定的尸体上解剖了 50 个半髋，借助大转子（GT）、髂骨结节、髂骨结节（IschT）、镫骨下孔和镫骨上孔等解剖标记，研究了坐骨神经的走向和位置与 THA 不同方法的关系：我们在所有 50 个标本中都发现并暴露了坐骨神经，没有性别差异。在距GT后方22毫米处未发现坐骨神经。发现坐骨神经概率最高的区域是GT后方32至55毫米处，占39例（78%），因此为THA的不同方法定义了一个危险区域：结论：在THA手术中，应特别注意在GT和IschT之间的后方和深部放置器械。此外，在后入路近端三分之一处进行深部和后部操作时应格外小心。

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The anatomical course of the sciatic nerve in relation to different approaches in total hip arthroplasty.

Purpose: Although sciatic nerve (SN) injury is relatively rare, it is a devastating complication after primary and revision total hip arthroplasty (THA). Therefore, precise localization of the SN is essential for arthroplasty surgeons.

Methods: We dissected 50 hemipelves from formalin-fixed cadavers. The course and location of the sciatic nerve were investigated in relation to different approaches for THA with the help of anatomical landmarks like the greater trochanter (GT), the iliac tubercle, the ischial tuberosity (IschT), the infrapiriform foramen, and the suprapiriform foramen.

Results: We found and exposed the sciatic nerve in all 50 specimens with no sex-specific differences. No SN was encountered up to 22 mm posterior from the GT. The zone affording the highest probability of finding the nerve was posterior to the GT between 32 and 55 mm in 39 (78%) cases, thus defining a danger zone for different approaches for the THA.

Conclusion: Special care should be taken with posterior and deep instrument placement between the GT and IschT during THA. Moreover, manipulations in the proximal third of the posterior approach reaching deep and posteriorly should be performed with the utmost care.

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来源期刊

International Orthopaedics 医学-整形外科

CiteScore

5.50

自引率

7.40%

发文量

360

审稿时长

1 months

期刊介绍： International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters. Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.