Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
Department of Radiology, Chiba University Hospital, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
BMC Musculoskelet Disord. 2023 Oct 19;24(1):824. doi: 10.1186/s12891-023-06947-0.
Femoral neurovascular injury is a serious complication in a direct anterior approach (DAA) total hip arthroplasty. However, dynamic neurovascular bundle location changes during the approach were not examined. Thus, this study aimed to analyze the effects of leg position on the femoral neurovascular bundle location using magnetic resonance imaging (MRI).
This study scanned 30 healthy volunteers (15 males and 15 females) with 3.0T MRI in a supine and 30-degree hip extension position with the left leg in a neutral rotation position and the right leg in a 45-degree external extension position. The minimum distance from the edge of the anterior acetabulum to the femoral nerve (dFN), artery, and vein were measured on axial T1-weighted images at the hip center level, as well as the angle to the horizontal line of the femoral nerve (aFN), artery (aFA), and vein from the anterior acetabulum.
The dFN in the supine position with external rotation was significantly larger than supine with neutral and extension with external rotation position (20.7, 19.5, and 19.0; p = 0.031 and 0.012, respectively). The aFA in supine with external rotation was significantly larger than in other postures (52.4°, 34.2°, and 36.2°, p < 0.001, respectively). The aFV in supine with external rotation was significantly larger than in supine with a neutral position (52.3° versus 47.7°, p = 0.037). The aFN in supine and external rotation was significantly larger than other postures (54.6, 38.2, and 33.0, p < 0.001, respectively).
This radiographic study revealed that the leg position affected the neurovascular bundle location. These movements can be the risk of direct neurovascular injury or traction.
股神经血管损伤是直接前入路（DAA）全髋关节置换术的严重并发症。然而，在入路过程中，神经血管束的位置变化并未被研究。因此，本研究旨在使用磁共振成像（MRI）分析腿位对股神经血管束位置的影响。
本研究使用 3.0T MRI 对 30 名健康志愿者（15 名男性和 15 名女性）进行扫描，分别处于仰卧位和 30 度髋关节伸展位，左腿处于中立旋转位，右腿处于 45 度外展位。在髋关节中心水平的轴位 T1 加权图像上测量从髋臼前缘到股神经（dFN）、动脉和静脉的最小距离，以及从髋臼前缘到股神经（aFN）、动脉（aFA）和静脉的角度。
在仰卧位外旋位时，dFN 明显大于仰卧位中立位和外展位外旋位（20.7、19.5 和 19.0；p=0.031 和 0.012）。在仰卧位外旋位时，aFA 明显大于其他体位（52.4°、34.2°和 36.2°，p<0.001）。在仰卧位外旋位时，aFV 明显大于仰卧位中立位（52.3°对 47.7°，p=0.037）。在仰卧位和外旋位时，aFN 明显大于其他体位（54.6°、38.2°和 33.0°，p<0.001）。
本研究表明，腿位会影响神经血管束的位置。这些运动可能会导致直接的神经血管损伤或牵引。
