Institute of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Muellerstr. 59, Innsbruck, 6020, Austria.
Department of Obstetrics and Gynecology, Schwaz County Hospital, Swarovskistr. 1-3, Schwaz, 6130, Austria.
Int Orthop. 2024 Oct;48(10):2561-2566. doi: 10.1007/s00264-024-06281-7. Epub 2024 Aug 26.
Although sciatic nerve (SN) injury is relatively rare, it is a devastating complication after primary and revision total hip arthroplasty (THA). Therefore, precise localization of the SN is essential for arthroplasty surgeons.
We dissected 50 hemipelves from formalin-fixed cadavers. The course and location of the sciatic nerve were investigated in relation to different approaches for THA with the help of anatomical landmarks like the greater trochanter (GT), the iliac tubercle, the ischial tuberosity (IschT), the infrapiriform foramen, and the suprapiriform foramen.
We found and exposed the sciatic nerve in all 50 specimens with no sex-specific differences. No SN was encountered up to 22 mm posterior from the GT. The zone affording the highest probability of finding the nerve was posterior to the GT between 32 and 55 mm in 39 (78%) cases, thus defining a danger zone for different approaches for the THA.
Special care should be taken with posterior and deep instrument placement between the GT and IschT during THA. Moreover, manipulations in the proximal third of the posterior approach reaching deep and posteriorly should be performed with the utmost care.
尽管坐骨神经（SN）损伤相对较少，但它是初次和翻修全髋关节置换术（THA）后的一种毁灭性并发症。因此，对于关节置换外科医生来说，准确定位 SN 至关重要。
我们解剖了 50 具福尔马林固定的尸体半骨盆。借助大转子（GT）、髂结节、坐骨结节（IschT）、梨状窝下孔和梨状窝上孔等解剖学标志，研究了坐骨神经在不同 THA 入路中的走行和位置。
我们在所有 50 个标本中都找到了并暴露了坐骨神经，没有性别特异性差异。在 GT 后 22 毫米处没有遇到 SN。在 39 例（78%）中，GT 后 32 至 55 毫米之间是发现神经概率最高的区域，因此定义了 THA 不同入路的危险区域。
在 THA 过程中，应特别注意 GT 和 IschT 之间的后向和深部器械放置。此外，在进行后入路近端三分之一的深部和后向操作时，应格外小心。
