Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Clin Anat. 2022 May;35(4):477-481. doi: 10.1002/ca.23823. Epub 2021 Dec 15.
Although superior gluteal nerve (SGN) injury can have significant morbidity, to date, surgical strategies for its repair are scant in the literature. Specifically, neurotization options have not been explored. To address this deficiency in the literature, the current cadaveric feasibility study was performed. Via a transgluteal approach on 16 cadaveric sides, the proximal sciatic nerve and the entrance of the SGN into the gluteus medius and minimus were identified. Additionally, branches from the sciatic nerve to the hamstring muscles were traced proximally to confirm their position in relation to the sciatic nerve as a whole. These branches were cut at the level of the ischial tuberosity and teased away from the sciatic nerve proximally to the greater sciatic foramen and transferred superolateral to the SGN. The diameter of each nerve branch was measured as well as its available length for reaching the SGN. All branches of the sciatic nerve to the hamstring muscles arose from the anteromedial part of the nerve. The mean diameters of the branches to the semimembranosus, semitendinosus, and biceps femoris muscles were 2.1, 1.9, and 1.5 mm, respectively. The mean diameter of the SGN was 3.1 mm and the mean distance from this entrance point to the ischial spine was 7.2 cm. The mean length of the donor nerve was 8.5 cm. Based on our study, use of a tibial-innervated hamstring branch as a donor for nerve transfer to the SGN is feasible.
尽管臀上神经 (SGN) 损伤可能会导致严重的发病率，但迄今为止，文献中关于其修复的手术策略却很少。具体来说，神经化选择尚未得到探索。为了解决文献中的这一不足，目前进行了尸体可行性研究。通过 16 具尸体侧的经臀入路，确定了坐骨神经近端和 SGN 进入臀中肌和臀小肌的入口。此外，还追踪了来自坐骨神经至腘绳肌的分支，以确认其在整个坐骨神经中的位置。在坐骨结节水平将这些分支切断，并从坐骨神经近端向坐骨大孔上方和 SGN 外侧松解，以将其转移。测量了每个神经分支的直径及其到达 SGN 的可用长度。所有来自坐骨神经至腘绳肌的分支均起源于神经的前内侧部分。半膜肌、半腱肌和股二头肌分支的平均直径分别为 2.1、1.9 和 1.5mm。SGN 的平均直径为 3.1mm，从该入口点到坐骨棘的平均距离为 7.2cm。供体神经的平均长度为 8.5cm。根据我们的研究，使用胫神经支配的腘绳肌分支作为 SGN 神经转移的供体是可行的。
