Martin Hal David, Khoury Anthony N, Schroder Ricardo, Gomez-Hoyos Juan, Yeramaneni Samrat, Reddy Manoj, James Palmer Ian
Hip Preservation Center, Baylor University Medical Center at Dallas, TX, USA.
Bioengineering Department, University of Texas at Arlington, TX, USA.
J Hip Preserv Surg. 2017 Apr 11;4(2):178-186. doi: 10.1093/jhps/hnx008. eCollection 2017 Jul.
Terminal hip flexion contributes to increased strain in peripheral nerves at the level of the hip joint. The effects of hip abduction and femoral version on sciatic nerve biomechanics are not well understood. A decrease in sciatic nerve strain will be observed during terminal hip flexion and hip abduction, independent of femoral version. Six un-embalmed human cadavers were utilized. Three Differential Variable Reluctance Transducers (DVRTs) sensors were placed on the sciatic nerve while the leg was flexed to 70° with a combination of - 10°, 0°, 20° and 40° adduction/abduction. DVRT placement included: (i) under piriformis, (ii) immediately distal to the gemelli/obturator, (iii) four centimeters distal to sensor two. A de-rotational osteotomy to decrease femoral version 10° was performed, and sciatic nerve strain was measured by the same procedure. Data were analyzed with three-way analysis of variance and Bonferroni analysis to identify differences in the mean values of sciatic nerve strain between native and decreased version state, hip abduction angle and DVRT sensor location. Significant main effects were observed for femoral version ( = 0.04) and DVRT sensor location ( = 0.01). Sciatic nerve strain decreased during terminal hip flexion and abduction in the decreased version state. An 84.23% decrease in sciatic nerve strain was observed during hip abduction from neutral to 40° in the presence of decreased version at terminal hip flexion. The results obtained from this study confirm the role of decreased femoral version and hip abduction at terminal hip flexion to decrease the strain in the sciatic nerve.
髋关节终末屈曲会导致髋关节水平外周神经的应变增加。髋关节外展和股骨扭转对坐骨神经生物力学的影响尚未得到充分了解。在髋关节终末屈曲和外展过程中，无论股骨扭转如何，均可观察到坐骨神经应变降低。本研究使用了6具未防腐处理的人体尸体。在腿部屈曲至70°并结合 -10°、0°、20°和40°内收/外展时，将三个差动可变磁阻换能器（DVRT）传感器置于坐骨神经上。DVRT的放置位置包括：（i）梨状肌下方，（ii）闭孔肌/闭孔外肌远端紧邻处，（iii）传感器2远端4厘米处。进行了一次去旋转截骨术以将股骨扭转减少10°，并通过相同程序测量坐骨神经应变。采用三因素方差分析和Bonferroni分析对数据进行分析，以确定在股骨扭转正常和减少状态、髋关节外展角度以及DVRT传感器位置之间坐骨神经应变平均值的差异。观察到股骨扭转（P = 0.04）和DVRT传感器位置（P = 0.01）有显著的主效应。在股骨扭转减少状态下，髋关节终末屈曲和外展时坐骨神经应变降低。在髋关节终末屈曲时股骨扭转减少的情况下，从髋关节中立位外展至40°时，观察到坐骨神经应变降低了84.23%。本研究所得结果证实了股骨扭转减少以及髋关节终末屈曲时髋关节外展在降低坐骨神经应变方面的作用。
