Tempski Jonasz, Kotlarek Aneta, Pękala Jakub, Fibiger Grzegorz, Krager Eirik, Łazarz Dominik, Rosa Mateusz, Glądys Kinga, Walocha Jerzy A, Pękala Przemysław
International Evidence-Based Anatomy Working Group, Kraków, Poland.
Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.
J Anat. 2025 Apr;246(4):467-478. doi: 10.1111/joa.14174. Epub 2024 Dec 3.
The superior gluteal nerve (SGN) is a mixed nerve of the sacral plexus that arises from the posterior divisions of the L4, L5, and S1 nerve roots. Its motor branch plays a crucial role in innervation of hip muscles, which allows for physiological gait or walk-pattern. As for its sensory branch, it provides innervation for the hip joint capsule, especially its superior part. The understanding of this nerve is crucial as it may be injured during many operations involving mostly pelvic surgery, both arthroscopic and open procedures. The risk of injury is especially high during total hip arthroplasty (THA). These lesions often result in the presentation of major walk-pattern abnormalities. The most classical and commonly known would be the Trendelenburg sign, which presents with pelvic instability characterized by having the patient standing on one leg whereby the pelvis on the contralateral side will be dropping, resulting in a positive sign. The aim of this meta-analysis was to obtain all relevant data on SGN and its variations, in order to emphasize its anatomical, physiological, as well as clinical implications. A large-scale search was conducted in all major databases (PubMed, Embase, Science Direct, Google Scholar, and Web of Science) in order to determine and pool all available and relevant SGN data. No restrictions were applied to date or language. The data collection was categorized by prevalence, branching, patterns, course, origin, and distance from anatomical landmarks. A total of 41 studies (n = 869 hemipelves) were included in our analysis. The most common branching pattern of SGN was a spray pattern, 70.4% (95% CI: 54.4-96.8; p < 0.001) of the general population. We found that the closest branch to the greater trochanter of the femur and concurrently the most at risk during surgery was a muscular branch to gluteus minimus muscle. As the trend of pelvic surgeries, especially THA continues to rise, SGN lesions are now more than ever at risk. Yet to the authors' knowledge, this does not seem to be reflected in the current literature thereby making this the first meta-analysis concerning this important anatomical structure. The authors believe it is paramount for surgeons, especially in the orthopedic specialty, to thoroughly understand the SGN with its anatomical variability and clinical tie-ins.
臀上神经（SGN）是骶丛的混合神经，由腰4、腰5和骶1神经根的后支发出。其运动支在髋关节肌肉的神经支配中起关键作用，这使得正常步态或行走模式成为可能。至于其感觉支，它为髋关节囊，尤其是其上部提供神经支配。了解这条神经至关重要，因为在许多手术中，尤其是涉及骨盆手术的关节镜和开放手术中，它可能会受到损伤。在全髋关节置换术（THA）期间，损伤风险尤其高。这些损伤通常会导致主要的行走模式异常。最经典且广为人知的是臀中肌步态，其表现为骨盆不稳定，特征是让患者单腿站立时，对侧骨盆会下降，从而产生阳性体征。本荟萃分析的目的是获取有关臀上神经及其变异的所有相关数据，以强调其解剖学、生理学以及临床意义。在所有主要数据库（PubMed、Embase、Science Direct、谷歌学术和科学网）中进行了大规模搜索以确定并汇总所有可用的相关臀上神经数据。对日期或语言没有限制。数据收集按发生率、分支、模式、走行、起源以及与解剖标志的距离进行分类。我们的分析共纳入41项研究（n = 869个半骨盆）。臀上神经最常见的分支模式是扇形模式，占普通人群的70.4%（95%可信区间：54.4 - 96.8；p < 0.001）。我们发现，最靠近股骨大转子且在手术期间风险最高的分支是至臀小肌的肌支。随着骨盆手术，尤其是全髋关节置换术的趋势持续上升，臀上神经损伤的风险比以往任何时候都更高。然而据作者所知，目前的文献中似乎并未体现这一点，因此这是关于这一重要解剖结构的首次荟萃分析。作者认为，外科医生，尤其是骨科专业的医生，全面了解臀上神经及其解剖变异和临床关联至关重要。
