Kaiser Radek, Khadanovich Anhelina, Benes Michal, Reynolds Jeremy, Mawhinney Gerard, Giele Henk, Kachlik David
Department of Spinal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford , UK.
Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague , Czech Republic.
Neurosurgery. 2025 Mar 1;96(3):505-513. doi: 10.1227/neu.0000000000003135. Epub 2024 Aug 12.
En bloc sacrectomy is associated with sacral root transection causing loss of urinary bladder, rectum, and sexual function. The aim of the study was to determine the position of the pudendal branches (sensorimotor) and pelvic splanchnic nerves (parasympathetic) on the sacral roots relative to the sacrum, and the minimal and maximal defects in the sacral roots that can be reconstructed by grafting after various types of sacrectomy.
Five cadaveric pelves were dissected bilaterally. The lengths and widths of the S1-S4 roots and their branches were measured. Then, the minimal and maximal defects between the proximal and distal stumps of the sacrificed roots were measured following 3 models of sacrectomy (below S2, below S1, and total sacrectomy).
The mean distance of the splanchnic nerves from the S2 and S3 anterior sacral foramina was 17.7 ± 7.3 and 23.6 ± 11.1 mm, respectively, and the mean distance of the pudendal S2 and S3 branches was 36.8 ± 13.7 and 30.2 ± 10.8 mm, respectively. The mean widths of the S2 and S3 roots were 9.3 ± 1.9 and 5.4 ± 1.2 mm, respectively. The mean maximal defects in S2 and S3 roots after various types of sacrectomies were between 61.8 ± 16.3 and 100.7 ± 14.3 mm and between 62.7 ± 20.2 and 84.7 ± 25.1 mm, respectively. There were no statistically significant differences between sides or sexes for all obtained measurements.
The reconstruction of the S2-S3 roots is anatomically feasible after partial or total sacrectomies in which the resection of the soft tissue does not extend further than approximately 1.5 to 2 cm ventrally from the sacrum.
整块骶骨切除术会导致骶神经根横断，进而引起膀胱、直肠及性功能丧失。本研究的目的是确定阴部支（感觉运动）和盆内脏神经（副交感神经）在骶神经根上相对于骶骨的位置，以及在各种类型的骶骨切除术后通过移植可重建的骶神经根的最小和最大缺损。
对五具尸体骨盆进行双侧解剖。测量S1 - S4神经根及其分支的长度和宽度。然后，在三种骶骨切除模型（S2以下、S1以下和全骶骨切除术）后，测量牺牲神经根近端和远端残端之间的最小和最大缺损。
内脏神经距S2和S3骶前孔的平均距离分别为17.7±7.3毫米和23.6±11.1毫米，阴部神经S2和S3分支的平均距离分别为36.8±13.7毫米和30.2±10.8毫米。S2和S3神经根的平均宽度分别为9.3±1.9毫米和5.4±1.2毫米。各种类型骶骨切除术后S2和S3神经根的平均最大缺损分别在61.8±16.3毫米至100.7±14.3毫米之间以及62.7±20.2毫米至84.7±25.1毫米之间。所有测量结果在左右侧或性别之间均无统计学显著差异。
在软组织切除不超过从骶骨腹侧约1.5至2厘米的部分或全骶骨切除术后，S2 - S3神经根的重建在解剖学上是可行的。
