Tomaszewski Krzysztof A, Graves Matthew J, Henry Brandon Michael, Popieluszko Patrick, Roy Joyeeta, Pękala Przemysław A, Hsieh Wan Chin, Vikse Jens, Walocha Jerzy A
International Evidence-Based Anatomy Working Group, Krakow, Poland.
Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland.
J Orthop Res. 2016 Oct;34(10):1820-1827. doi: 10.1002/jor.23186. Epub 2016 Feb 22.
The sciatic nerve has varying anatomy with respect to the piriformis muscle. Understanding this variant anatomy is vital to avoiding iatrogenic nerve injuries. A comprehensive electronic database search was performed to identify articles reporting the prevalence of anatomical variations or morphometric data of the sciatic nerve. The data found was extracted and pooled into a meta-analysis. A total of 45 studies (n = 7068 lower limbs) were included in the meta-analysis on the sciatic nerve variations with respect to the piriformis muscle. The normal Type A variation, where the sciatic nerve exits the pelvis as a single entity below the piriformis muscle, was most common with a pooled prevalence of 85.2% (95%CI: 78.4-87.0). This was followed by Type B with a pooled prevalence of 9.8% (95%CI: 6.5-13.2), where the sciatic nerve bifurcated in the pelvis with the exiting common peroneal nerve piercing, and the tibial nerve coursing below the piriformis muscle. In morphometric analysis, we found that the pooled mean width of the sciatic nerve at the lower margin of the piriformis muscle was 15.55 mm. The pooled mean distance of sciatic nerve bifurcation from the popliteal fossa was 65.43 mm. The sciatic nerve deviates from its normal course of pelvic exit in almost 15% of cases. As such we recommend that a thorough assessment of sciatic nerve variants needs to be considered when performing procedures in the pelvic and gluteal regions in order to reduce the risk of iatrogenic injury. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1820-1827, 2016.
坐骨神经与梨状肌的解剖结构存在差异。了解这种变异的解剖结构对于避免医源性神经损伤至关重要。我们进行了全面的电子数据库搜索，以识别报告坐骨神经解剖变异患病率或形态学数据的文章。提取找到的数据并汇总进行荟萃分析。关于坐骨神经相对于梨状肌的变异，共有45项研究（n = 7068条下肢）纳入了荟萃分析。正常的A型变异最为常见，即坐骨神经作为一个整体在梨状肌下方穿出骨盆，汇总患病率为85.2%（95%CI：78.4 - 87.0）。其次是B型，汇总患病率为9.8%（95%CI：6.5 - 13.2），即坐骨神经在骨盆内分叉，腓总神经穿出，胫神经在梨状肌下方走行。在形态学分析中，我们发现梨状肌下缘处坐骨神经的汇总平均宽度为15.55毫米。坐骨神经分叉处距腘窝的汇总平均距离为65.43毫米。在近15%的病例中，坐骨神经偏离其正常的骨盆出口路径。因此，我们建议在骨盆和臀区进行手术时，需要对坐骨神经变异进行全面评估，以降低医源性损伤的风险。© 2016年骨科研究协会。由威利期刊公司出版。《矫形外科学研究》34:1820 - 1827，2016年。
