Apaydin Nihal, Bozkurt Murat, Loukas Marios, Tubbs R Shane, Esmer Ali F
Department of Anatomy, Ankara University School of Medicine, Sihhiye, 06100 Ankara, Turkey.
Surg Radiol Anat. 2009 Jul;31(6):415-8. doi: 10.1007/s00276-008-0459-6. Epub 2009 Feb 4.
The position of the inferior gluteal nerve (IGN) makes it vulnerable to iatrogenic injury during posterior and posterolateral approaches to the hip. Although the posterior approach has been reported to be the most frequently used technique, it is most likely to be associated with damage to the IGN. As there is scant information in the literature regarding the course and the anatomic relationships of the IGN, we aimed to investigate the anatomic course of the IGN and define the anatomical landmarks that can be used by surgeons during posterior approaches to the hip. Thirty-six gluteal regions from adult fixed cadavers were used for this study. A triangular-shaped anatomic area that contains the IGN was defined. This geometric area was formed by connecting the following points: posterior inferior iliac spine (PIIS) (apex), ischial tuberosity (IT) and greater trochanter (GT). This triangle can further be divided into two, the upper triangle being the "danger zone" since it contains the IGN and its branches. The closest mean distance between the point of IGN origin and the PIIS, IT and the GT was 3.2, 4.8 and 5.4 cm, respectively. In all specimens, the nerve entered the deep surface of the gluteus maximus approximately 5.4 cm from the apex of the GT and approached the GT as close as 0.8 cm, on average. Based on our study, dividing the gluteus maximus with standard techniques may damage the IGN. Posterior minimally invasive approaches to the hip should take into account the point of entry of the IGN into the gluteus maximus. Localization of the IGN by using the anatomic triangle defined in this study may decrease surgical morbidity.
臀下神经(IGN)的位置使其在髋关节后入路和后外侧入路手术中易受医源性损伤。尽管后入路据报道是最常用的技术,但它最有可能与IGN损伤相关。由于文献中关于IGN走行及解剖关系的信息很少,我们旨在研究IGN的解剖走行,并确定外科医生在髋关节后入路手术中可利用的解剖标志。本研究使用了36个来自成年固定尸体的臀区。定义了一个包含IGN的三角形解剖区域。这个几何区域由以下几点连接而成:髂后下棘(PIIS)(顶点)、坐骨结节(IT)和大转子(GT)。这个三角形可进一步分为两个三角形,上三角形为“危险区”,因为它包含IGN及其分支。IGN起点与PIIS、IT和GT之间的平均最短距离分别为3.2 cm、4.8 cm和5.4 cm。在所有标本中,神经在距GT顶点约5.4 cm处进入臀大肌深面,平均距离GT最近处为0.8 cm。基于我们的研究,用标准技术分离臀大肌可能会损伤IGN。髋关节后微创入路应考虑IGN进入臀大肌的点。利用本研究中定义的解剖三角形定位IGN可能会降低手术并发症的发生率。