Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania 19140-5104, USA.
J Neurosurg Spine. 2011 Nov;15(5):526-31. doi: 10.3171/2011.6.SPINE11163. Epub 2011 Jul 15.
Nerve transfers are an effective means of restoring control to paralyzed somatic muscle groups and, recently, even denervated detrusor muscle. The authors performed a cadaveric pilot project to examine the feasibility of restoring control to the urethral and anal sphincters using a femoral motor nerve branch to reinnervate the pudendal nerve through a perineal approach.
Eleven cadavers were dissected bilaterally to expose the pudendal and femoral nerve branches. Pertinent landmarks and distances that could be used to locate these nerves were assessed and measured, as were nerve cross-sectional areas.
A long motor branch of the femoral nerve was followed into the distal vastus medialis muscle for a distance of 17.4 ± 0.8 cm, split off from the main femoral nerve trunk, and transferred medially and superiorly to the pudendal nerve in the Alcock canal, a distance of 13.7 ± 0.71 cm. This was performed via a perineal approach. The cross-sectional area of the pudendal nerve was 5.64 ± 0.49 mm(2), and the femoral nerve motor branch at the suggested transection site was 4.40 ± 0.41 mm(2).
The use of a femoral nerve motor branch to the vastus medialis muscle for heterotopic nerve transfer to the pudendal nerve is surgically feasible, based on anatomical location and cross-sectional areas.
神经转移是恢复瘫痪躯体肌肉群功能的有效手段，最近甚至可以恢复去神经支配的逼尿肌功能。作者进行了一项尸体试点项目，通过会阴入路，使用股神经运动支分支重新支配阴部神经，以恢复尿道和肛门括约肌的控制。
对 11 具尸体进行双侧解剖，暴露阴部神经和股神经分支。评估和测量了可用于定位这些神经的相关标志和距离，以及神经的横截面积。
股神经的一个长运动支在股直肌的远端延伸 17.4±0.8cm，从股神经主干分出，转移至阴部神经在 Alcock 管内，距离为 13.7±0.71cm。这是通过会阴入路完成的。阴部神经的横截面积为 5.64±0.49mm²，建议切断部位的股神经运动支为 4.40±0.41mm²。
根据解剖位置和横截面积，使用股直肌的股神经运动支进行异位神经转移至阴部神经在手术上是可行的。
