Choi Seonui, Yang Hun-Mu, Cho Tae-Hyeon, Yeo In-Seung, Won Sung-Yoon
Translational Laboratory for Clinical Anatomy, Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea.
Surgical Anatomy Education Centre, Yonsei University College of Medicine, Seoul, Republic of Korea.
Clin Anat. 2023 Nov;36(8):1089-1094. doi: 10.1002/ca.24034. Epub 2023 Mar 10.
The aims of this study were to clarify the extra- and intramuscular branching patterns of the tensor fasciae latae (TFL) with reference to surface landmarks on the thigh and to thus suggest a safe approach for total hip arthroplasty. Sixteen fixed and four fresh cadavers were dissected and subjected to the modified Sihler's staining method to reveal the extra- and intramuscular innervation patterns, and the findings were matched with surface landmarks. The landmarks were measured from the anterior superior iliac spine (ASIS) to the patella and divided into 20 parts along the total length. The average vertical length of the TFL was 15.92 ± 1.61 cm, which was 38.79 ± 2.73% when converted to a percentage. The entry point of the superior gluteal nerve (SGN) was an average of 6.87 ± 1.26 cm (16.71 ± 2.55%) from the ASIS. In all cases, the SGN entered parts 3-5 (10.1%-25%). As the intramuscular nerve branches traveled distally, they had a tendency to innervate more deeply and inferiorly. In all cases, the main SGN branches were intramuscularly distributed in parts 4 and 5 (15.1%-25%). Most tiny SGN branches were found inferiorly in parts 6 and 7 (25.1%-35%). In three of 10 cases, very tiny SGN branches were observed in part 8 (35.1%-38.79%). We did not observe SGN branches in parts 1-3 (0%-15%). When information on the extra- and intramuscular nerve distributions was combined, we found that the nerves were concentrated in parts 3-5 (10.1%-25%). We propose that damage to the SGN can be prevented if parts 3-5 (10.1%-25%) are avoided during surgical treatment, particularly during the approach and incision.
本研究的目的是参照大腿的体表标志，阐明阔筋膜张肌（TFL）的肌外和肌内分支模式，从而为全髋关节置换术提出一种安全的入路方法。对16具固定尸体和4具新鲜尸体进行解剖，并采用改良的席勒染色法来显示肌外和肌内神经支配模式，然后将结果与体表标志进行匹配。这些标志从髂前上棘（ASIS）测量至髌骨，并沿全长分为20等份。阔筋膜张肌的平均垂直长度为15.92±1.61厘米，换算为百分比后为38.79±2.73%。臀上神经（SGN）的进入点距ASIS平均为6.87±1.26厘米（16.71±2.55%）。在所有病例中，SGN进入第3 - 5部分（10.1% - 25%）。随着肌内神经分支向远端走行，它们有向更深层和更低部位支配的趋势。在所有病例中，SGN的主要分支在第4和第5部分（15.1% - 25%）呈肌内分布。大多数微小的SGN分支在第6和第7部分（25.1% - 35%）的下方被发现。在10例中的3例中，在第8部分（35.1% - 38.79%）观察到非常微小的SGN分支。在第1 - 3部分（0% - 15%）未观察到SGN分支。当将肌外和肌内神经分布的信息结合起来时，我们发现神经集中在第3 - 5部分（10.1% - 25%）。我们建议，在手术治疗期间，特别是在入路和切口过程中，如果避开第3 - 5部分（10.1% - 25%），可以防止SGN受损。
