State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.
Branch of National Clinical Research Center for Orthopedics, Sports Medicine Rehabilitation, Nanjing, People's Republic of China.
J Orthop Surg Res. 2021 Oct 18;16(1):623. doi: 10.1186/s13018-021-02763-1.
The postoperative complaints of hypoesthesia or a burning sensation due to lateral femoral cutaneous nerve (LFCN) injury in patients are not yet solved. The present study aimed to identify the three-dimensional (3D) distribution of LFCN using preoperative ultrasound and evaluate the rate of injury in direct anterior approach for total hip arthroplasty.
A total of 59 patients (28 males and 31 females, age 69.0 ± 4.6 years, BMI 24.7 ± 3.0 kg/m) were randomly allocated to the ultrasound group and 58 patients (28 males and 30 females, age 68.5 ± 4.5 years, BMI 24.8 ± 2.8 kg/m) were in the control group. Surgeons received the data of 3D distribution of LFCN only in the ultrasound group before surgery with respect to the direction, the depth on the skin, and the length to tensor fasciae latae (TFL). The anatomical characteristics of LFCN in the surgical region were summarized. At 1 and 3 months of post surgery, the rate of LFCN injury and abnormal sensitive area was evaluated in both groups.
There was a significant consistency in gender, age and BMI of these two groups (P > 0.05). Based on the data from the ultrasound group, over 90% of patients had one or two branches of LFCN. LFCN always courses in the fascia layer, the depth ranged from 6.8 ± 2.6 (3.0-12.0) mm to 11.1 ± 3.4 (4.0-17.0) mm and depended on the thickness of the subcutaneous fat, and length was 3.3 ± 4.6 (- 5.0-10.0) mm at proximal part and - 2.7 ± 4.7 (- 10.0-8.0) at distal end to the medial edge of TFL. Both the rate of LFCN injury and abnormal sensory area in the ultrasound group was significantly lower than those in the control group (3.4% vs. 25.9%, P = 0.001, at 1 month; 3.4% vs. 22.4%, P = 0.005, at 3 months).
LFCN mostly courses along the medial border of TFL in the fascia layer. The 3D distribution of LFCN using preoperative ultrasound mapping could help the surgeons to evaluate the risk of injury preoperatively and decrease the rate of injury during the operation. However, some branch injuries, especially for the fan type LFCN, could not be avoided.
由于股外侧皮神经（LFCN）损伤，患者术后会出现感觉减退或烧灼感等不适，这一问题仍未得到解决。本研究旨在通过术前超声确定 LFCN 的三维（3D）分布，并评估直接前路全髋关节置换术时 LFCN 损伤的发生率。
将 59 例患者（28 例男性，31 例女性；年龄 69.0±4.6 岁，BMI 24.7±3.0 kg/m）随机分为超声组，58 例患者（28 例男性，30 例女性；年龄 68.5±4.5 岁，BMI 24.8±2.8 kg/m）为对照组。仅在超声组的术前，外科医生会收到 LFCN 3D 分布的数据，包括方向、皮肤深度和与阔筋膜张肌（TFL）的长度。总结 LFCN 在手术区域的解剖特征。在术后 1 个月和 3 个月时，评估两组患者的 LFCN 损伤和异常敏感区的发生率。
两组患者的性别、年龄和 BMI 均具有显著一致性（P＞0.05）。基于超声组的数据，超过 90%的患者有 1 支或 2 支 LFCN 分支。LFCN 始终在筋膜层中穿行，其深度范围为 6.8±2.6（3.0-12.0）mm 至 11.1±3.4（4.0-17.0）mm，取决于皮下脂肪的厚度，近端长度为 3.3±4.6（-5.0-10.0）mm，远端至 TFL 内侧缘为-2.7±4.7（-10.0-8.0）mm。超声组的 LFCN 损伤率和异常感觉区发生率均明显低于对照组（3.4%比 25.9%，P=0.001，术后 1 个月；3.4%比 22.4%，P=0.005，术后 3 个月）。
LFCN 大多沿 TFL 的内侧缘在筋膜层中走行。术前超声映射的 LFCN 3D 分布有助于外科医生术前评估损伤风险，并降低术中损伤的发生率。然而，仍有一些分支损伤，特别是扇形 LFCN，无法避免。
