University of Illinois at Chicago, U.S.A.
University of Illinois at Chicago, U.S.A.
Arthroscopy. 2014 Apr;30(4):462-7. doi: 10.1016/j.arthro.2013.12.012. Epub 2014 Feb 21.
To measure the distances of pertinent neurovascular structures from bony landmarks used during hip arthroscopy and compare them among different demographic groups.
The distances from neurovascular structures to bony landmarks often used during hip arthroscopy were measured on magnetic resonance images of the hip in 100 patients. The structures studied include the lateral femoral cutaneous nerve (LFCN), sciatic nerve, femoral nerve, and femoral artery. These distances were then compared across different demographic groups, and statistical analysis was performed.
The mean anteroposterior (AP) distance from the tip of the greater trochanter to the sciatic nerve was 10.32 mm (range, 0 to 23.8 mm). At the level of the superior tip of the greater trochanter, the mean distances from the anterior superior iliac spine reference line to the LFCN, femoral nerve, and femoral artery were 6.37 mm (range, -9.8 to 35.9 mm) for medial-lateral, 23.24 mm (range, 3.4 to 67.0 mm) for AP, and 26.34 mm (range, 7.3 to 65.5 mm) for AP, respectively. We found significant differences in distances for the LFCN, femoral nerve, and femoral artery for weight (P = .003, P = .041, and P = .004, respectively) and body mass index (P = .003, P = .010, and P = .003, respectively), as well as for the LFCN between whites and Hispanics (P = .032). There were also significant differences for the femoral nerve vector between African Americans and whites (P = .04), as well as between African Americans and Hispanics (P = .04).
We found the LFCN to be the most at-risk neurovascular structure with hip arthroscopy portal placement. This study also showed that there is wide variability in the locations of pertinent neurovascular structures across different demographic groups, including weight, body mass index, and race or ethnicity.
Portal placement during hip arthroscopy carries a risk of neurovascular injury, particularly to the LFCN. The clinician should be aware of the variability in structure location with different patient demographic characteristics.
测量髋关节镜检查中使用的相关神经血管结构与骨标志之间的距离，并比较不同人群之间的差异。
对 100 例髋关节磁共振图像中髋关节镜检查中常用的神经血管结构与骨标志之间的距离进行测量。研究的结构包括：股外侧皮神经（LFCN）、坐骨神经、股神经和股动脉。然后在不同的人群中进行比较，并进行统计学分析。
从大转子尖端到坐骨神经的前后（AP）距离的平均值为 10.32mm（范围，0 至 23.8mm）。在大转子尖端的上缘水平，从前上髂棘参考线到 LFCN、股神经和股动脉的平均距离分别为 6.37mm（范围，-9.8 至 35.9mm）、23.24mm（范围，3.4 至 67.0mm）和 26.34mm（范围，7.3 至 65.5mm）。我们发现，股外侧皮神经、股神经和股动脉的距离在体重（P=.003，P=.041 和 P=.004）和体重指数（P=.003，P=.010 和 P=.003）方面存在显著差异，并且白人和西班牙裔之间的 LFCN 也存在显著差异（P=.032）。股神经向量在非裔美国人和白种人之间（P=.04）以及非裔美国人和西班牙裔之间（P=.04）也存在显著差异。
我们发现，在髋关节镜检查的入路部位，股外侧皮神经是最易受损的神经血管结构。本研究还表明，不同人群的相关神经血管结构的位置存在广泛的变异性，包括体重、体重指数和种族或民族。
髋关节镜检查时的入路部位存在神经血管损伤的风险，尤其是股外侧皮神经。临床医生应该意识到，不同患者的人口统计学特征会导致结构位置的变化。
