Bonaddio Vincenzo A, Payne Russell, Harbaugh Kimberly, Rizk Elias, Fox Edward
Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.
Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, USA.
Cureus. 2021 Nov 8;13(11):e19349. doi: 10.7759/cureus.19349. eCollection 2021 Nov.
Sciatic nerve impingement via a tumor of or trauma to the proximal subgluteal region creates a considerable surgical challenge that is debated in the literature. The neurosurgery literature favors the infragluteal approach, while in orthopaedics, the transgluteal approach is preferred. The goal of our study was to present an operative technique for the infragluteal approach to the subgluteal region with a step-by-step procedural guide to increase awareness among orthopaedic surgeons of alternative surgical approaches to the sciatic notch. We retrospectively reviewed the case of a 62-year-old female found to have a subgluteal myxoma who underwent the infragluteal approach for tumor excision. We then highlighted the anatomic considerations via cadaveric dissection photographs, artistic renditions, and intra-operative images. Our patient underwent tumor resection and sciatic nerve exploration via the infragluteal approach with a successful outcome. In comparison to other approaches in the literature, the infragluteal approach provides a safer dissection with more options for an extension of the exposure and potentially fewer functional deficits. We conclude that orthopaedic surgeons should strongly consider utilizing this approach to the sciatic notch rather than a transgluteal approach.
坐骨神经在臀下区域近端因肿瘤或创伤受到压迫，这带来了相当大的手术挑战，相关文献对此存在争议。神经外科文献倾向于采用臀下入路，而在骨科领域，经臀入路更受青睐。我们研究的目的是介绍一种臀下区域臀下入路的手术技术，并提供分步操作指南，以提高骨科医生对坐骨切迹替代手术入路的认识。我们回顾性分析了一名62岁女性患者的病例，该患者被发现患有臀下黏液瘤，并接受了臀下入路肿瘤切除术。然后，我们通过尸体解剖照片、艺术绘图和术中图像强调了解剖学要点。我们的患者通过臀下入路进行了肿瘤切除和坐骨神经探查，结果成功。与文献中的其他入路相比，臀下入路提供了更安全的解剖，在扩大暴露范围方面有更多选择，并且潜在的功能缺陷可能更少。我们得出结论，骨科医生应强烈考虑采用这种坐骨切迹入路，而非经臀入路。
