Ince Akif, Kemper Max, Waschke Jens, Hendrich Christian
Department of Orthopaedics, University Hospital of Würzburg, Germany.
Acta Orthop. 2007 Feb;78(1):86-9. doi: 10.1080/17453670610013466.
Minimally invasive approaches to the hip show promise of less muscle trauma compared to conventional approaches. What is the risk of damage to the superior gluteal nerve? We studied the course of the superior gluteal nerve.
20 legs of 11 formalin-fixed Caucasian cadavers were dissected and the course and the distances of the superior gluteal nerve branches from the tip of the greater trochanter were documented.
The branch of the gluteal superior nerve leading to the gluteal minimus muscle was 33 (20-50) mm from the tip of the greater trochanter, within a deeper layer. The nearest point of the superior gluteal nerve branches from the tip of the greater trochanter in the posterior region was 19 (10-30) mm, in the middle region 20 (20-30) mm and in the anterior region 20 (10-35) mm. In half of the cases, a distal intermuscular branch between gluteal medius and tensor fasciae latae muscle could be found, mean 27 (10-40) mm caudal and 38 (25-60) mm ventral to the tip of the greater trochanter. This distal branch is considered to create a loop with upper branches of the superior gluteal nerve within the tensor fasciae muscle.
The safe zone for the superior gluteal nerve was smaller than previously reported. Use of a minimal direct lateral approach puts the inferior branches within the gluteal medius at risk; however, a minimal anterolateral approach to the hip may compromise branches of the superior gluteal nerve to the tensor fasciae latae muscle.
与传统入路相比，髋关节的微创入路显示出肌肉创伤较小的前景。臀上神经损伤的风险是什么？我们研究了臀上神经的走行。
解剖11具福尔马林固定的白种人尸体的20条腿，记录臀上神经分支距大转子尖的走行和距离。
通向臀小肌的臀上神经分支距大转子尖33（20 - 50）mm，位于较深层。臀上神经分支在后部距大转子尖最近点为19（10 - 30）mm，中部为20（20 - 30）mm，前部为20（10 - 35）mm。在半数病例中，可发现臀中肌和阔筋膜张肌之间的肌间远端分支，平均位于大转子尖尾侧27（10 - 40）mm和腹侧38（25 - 60）mm处。该远端分支被认为在阔筋膜张肌内与臀上神经的上部分支形成一个袢。
臀上神经的安全区比先前报道的要小。采用最小直接外侧入路会使臀中肌内的下部分支有损伤风险；然而，髋关节的最小前外侧入路可能会损害臀上神经至阔筋膜张肌的分支。
