Institute of Anatomy, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria
Institute of Anatomy, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria.
Br J Anaesth. 2014 Jun;112(6):1098-104. doi: 10.1093/bja/aet552. Epub 2014 Feb 18.
Interference with the function of the genitofemoral nerve (GFN) and lateral femoral cutaneous nerve (LFCN) represents a significant complication of lumbar sympathetic blocks (LSBs). The nerve topography of the lumbar sympathetic trunk (LST) was investigated to find a possible morphological reason for this.
A total of 118 cadavers embalmed by Thiel's method were investigated. The nerves were dissected from their innervation area to their paravertebral origins. Distances of the GFN and the LFCN to the LST were measured at levels L2/3, L3/4, and L4/5, which are the most common levels for LSB.
Two hundred and thirteen sides were assessable for the GFN and 151 sides for the LFCN. In 186 cases, the whole GFN (in 20 cases, its femoral branch only) approached the medial margin of the psoas major (PM) and passed the LST laterally at the level of L3/4 and a distance of 0-28 mm (mean distance 8.5 mm; sd 6.7 mm) and ran dorsally between the PM and the vertebral body of L3, reaching the intervertebral foramen L2/3. In three cases, the GFN fused with the LFCN. In 55 cases, the GFN-LST distance was 0-13 mm at L4/5 and in 19 cases, 9-19 mm at L2/3. The LFCN approached the lateral margin of the PM and entered the intervertebral foramen at L2/3 in 141 cases.
There is a higher risk of LSB affecting the GFN at L3/4 or L4/5 during neurolysis of the LST due to its topography. The LFCN rarely shows a strong relation to the LST and only when fused with the GFN.
生殖股神经（GFN）和股外侧皮神经（LFCN）功能障碍是腰椎交感神经阻滞（LSB）的一个重要并发症。本研究旨在探讨腰椎交感干（LST）的神经解剖学特点，以寻找其可能的形态学原因。
采用 Thiel 法对 118 具防腐固定尸体进行研究。从神经支配区域到椎旁起源处解剖神经。在 LSB 最常见的 L2/3、L3/4 和 L4/5 水平测量 GFN 和 LFCN 与 LST 的距离。
可评估 GFN 的侧别为 213 侧，LFCN 为 151 侧。在 186 例中，整个 GFN（20 例仅为其股支）接近腰大肌（PM）的内侧缘，在 L3/4 水平外侧通过 LST，距离为 0-28mm（平均距离 8.5mm；标准差 6.7mm），在 PM 和 L3 椎体之间向背侧走行，到达 L2/3 椎间孔。在 3 例中，GFN 与 LFCN 融合。在 55 例中，GFN-LST 距离在 L4/5 为 0-13mm，在 L2/3 为 9-19mm。在 141 例中，LFCN 接近 PM 的外侧缘，在 L2/3 进入椎间孔。
由于 LST 的解剖位置，在 LST 神经松解时，在 L3/4 或 L4/5 处行 LSB 更易影响 GFN，风险更高。LFCN 与 LST 很少有很强的关系，只有在与 GFN 融合时才会如此。
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