Seattle Science Foundation, Seattle, Washington, USA; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
World Neurosurg. 2019 Aug;128:e970-e974. doi: 10.1016/j.wneu.2019.05.045. Epub 2019 May 14.
Tumors of the greater sciatic foramen remain difficult to treat. They often have both intrapelvic and extrapelvic components that may limit visualization and make safe resection of the tumor difficult. Therefore the goal of the present anatomic study was to quantitate how much additional surgical working space could be gained by transection of the sacrospinous and sacrotuberous ligaments.
Sixteen sides from 9 fresh-frozen Caucasian cadaveric torsos underwent transgluteal dissection and exposure of the greater sciatic foramen and associated liagments. With the piriformis in place, the vertical and horizontal diameters of the greater sciatic foramen were measured. Next, the sacrotuberous and sacrospinous ligaments were cut at their ischial attachments. The vertical diameter of the now confluent greater and lesser sciatic foramina (V) was measured.
The mean vertical diameter of the greater sciatic foramen (V) was 54.8 ± 9.7 mm. The horizontal diameter of the greater sciatic foramen had a mean of 44.3 ± 6.1 mm with a range of 30-52 mm. After transection of the sacrotuberous and sacrospinous ligaments, the vertical distance of the greater and lesser sciatic foramina (V) had a mean of 74.8 ± 6.8 mm with a range of 60.1-90 mm. The mean ratio of V to V was 1.40.
The vertical length of the greater sciatic foramen increased, on average, 40% after resection of the sacrotuberous and sacrospinous ligaments. The results of this study support an alternative technique for resecting large intrapelvic tumors via a transgluteal approach.
坐骨大切迹内的肿瘤仍然难以治疗。它们通常既有盆腔内成分，也有盆腔外成分，这可能会限制对肿瘤的可视化，并使肿瘤的安全切除变得困难。因此，本解剖学研究的目的是量化切断骶棘和骶结节韧带可以获得多少额外的手术空间。
从 9 具新鲜冷冻的白种人尸体躯干中选择 16 侧进行经臀下解剖和坐骨大切迹及相关韧带的暴露。在梨状肌就位的情况下，测量坐骨大切迹的垂直和水平直径。然后，在坐骨结节附着处切断骶结节和骶棘韧带。测量现在融合的坐骨大切迹和小切迹（V）的垂直直径。
坐骨大切迹的平均垂直直径（V）为 54.8 ± 9.7mm。坐骨大切迹的水平直径平均为 44.3 ± 6.1mm，范围为 30-52mm。切断骶结节和骶棘韧带后，坐骨大切迹和小切迹的垂直距离（V）平均为 74.8 ± 6.8mm，范围为 60.1-90mm。V 与 V 的平均比值为 1.40。
切除骶结节和骶棘韧带后，坐骨大切迹的垂直长度平均增加 40%。本研究的结果支持一种通过经臀下入路切除大型盆腔内肿瘤的替代技术。
