Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, 113-8519 Bunkyo-ku, Tokyo, Japan.
Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, 113-8519 Bunkyo-ku, Tokyo, Japan.
Orthop Traumatol Surg Res. 2021 Dec;107(8):102817. doi: 10.1016/j.otsr.2021.102817. Epub 2021 Jan 20.
Neurovascular injury is a critical complication in total hip arthroplasty (THA). However, neurovascular geographic variations around the hip joint in different body positions have not been examined. This study investigated the differences in hip neurovascular geography in the supine and lateral positions using magnetic resonance imaging (MRI).
The neurovascular geography of the hip is influenced by differences in surgical body position.
This was a single-center prospective study of 15 healthy volunteers enrolled between January 2018 and March 2019. Each subject's bilateral hips were scanned with a 3-T MRI scanner in both the supine and lateral positions. In T1-weighted axial images at the level of the hip center, the anterior and posterior acetabular edges were defined as reference points at which retractors are commonly placed during surgery. We measured the distance between the anterior acetabular edge and the femoral nerve (dFN), femoral artery (dFA), and femoral vein (dFV), as well as that between the posterior acetabular edge and the sciatic nerve (dSN). The primary outcome measures were the distances in both the supine and lateral positions.
dFN, dFA, and dFV in the supine and lateral positions (mm, mean±standard deviation) were 25.8±5.6 and 32.4±6.4 (p<0.0001), 25.7±4.5 and 32.2±5.0 (p<0.0001), and 26.5±4.8 and 32.3±5.1 (p<0.0001), respectively. Most of these elements moved anteromedially in the lateral position compared to the supine position. There was no significant difference in dSN between the supine and lateral positions (23.7±4.9 and 24.5±6.5 (p=0.46).
THA in the supine position may be accompanied by a higher risk of femoral neurovascular injury than that in the lateral position. The application of our findings could reduce the risk of femoral neurovascular injury during THA.
III; prospective diagnostic case control study.
神经血管损伤是全髋关节置换术（THA）的一个关键并发症。然而，在不同体位下髋关节周围神经血管的地理变化尚未得到研究。本研究使用磁共振成像（MRI）研究了仰卧位和侧卧位髋关节神经血管的地理差异。
髋关节的神经血管解剖受手术体位的影响。
这是一项 2018 年 1 月至 2019 年 3 月期间在单中心进行的前瞻性研究，纳入了 15 名健康志愿者。每位受试者的双侧髋关节均在 3T MRI 扫描仪上分别行仰卧位和侧卧位扫描。在髋关节中心水平的 T1 加权轴位图像上，将髋臼前、后缘定义为手术中通常放置牵开器的参考点。我们测量了髋臼前缘与股神经（dFN）、股动脉（dFA）和股静脉（dFV）之间的距离，以及髋臼后缘与坐骨神经（dSN）之间的距离。主要观察指标为仰卧位和侧卧位的距离。
仰卧位和侧卧位的 dFN、dFA 和 dFV（mm，均值±标准差）分别为 25.8±5.6 和 32.4±6.4（p<0.0001）、25.7±4.5 和 32.2±5.0（p<0.0001）、26.5±4.8 和 32.3±5.1（p<0.0001）。与仰卧位相比，这些结构在侧卧位时向前内侧移动。dSN 在仰卧位和侧卧位之间无显著差异（23.7±4.9 和 24.5±6.5（p=0.46）。
与侧卧位相比，仰卧位行 THA 可能会增加股神经血管损伤的风险。应用我们的研究结果可能会降低 THA 过程中股神经血管损伤的风险。
III；前瞻性诊断病例对照研究。
