Sciatic nerve course in adult patients with unilateral developmental dysplasia of the hip: implications for hip surgery

Liu, Ruiyu; Liang, Jiawei; Wang, Kunzheng; Dang, Xiaoqian; Bai, Chuanyi

doi:10.1186/1471-2482-15-14

Cited by 12 publications

(18 citation statements)

References 28 publications

(27 reference statements)

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“…Supporting this, to reduce the risk of nerve kinking at the fragment edge, flexion of the hip is recommended. In contrast to these studies, the present study found higher distances from the nerve to the bone at the neutral position compared to [8][9][10] N abext 10 ± 1 [10][11] flexion or neutral/abduction/external rotation. This is probably due to the fact that the distance from the nerve to the bone was measured in this CT study rather than the tension of the nerve in a cadaver.…”

Section: Discussioncontrasting

confidence: 99%

“…We only included male adult participants with healthy hips. However, developmental hip dysplasia is mostly seen in female patients and patients with developmental hip dysplasia have altered anatomy also affecting the bone to nerve relationship and/or distance [9,10]. A second CT was used to measure the distances, which may not be as precise as with MR for identifying soft tissue but is superior to it for bone examination.…”

Section: Discussionmentioning

confidence: 99%

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A CT study of the femoral and sciatic nerve periacetabular moving in different hip positions

Işın¹,

Hapa

Kara

et al. 2020

J Orthop Surg Res

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Background Femoral and sciatic nerves could be damaged during various stages of the periacetabular osteotomy. Changing the position of the hip could be the most effective way of preventing nerve injuries. The purpose of the present study was to investigate the distances of the nerves to various bony landmarks with different hip positions in computerized pelvic scanograms of healthy adults. Materials and methods Fifteen healthy male adults (30 hips) (age 30 ± 6) were included. Scans were performed at three different hip positions measured by goniometer (neutral “N,” flexion (30–45°) + abduction (30–45°) + external rotation (20°) “F” and neutral+ abduction (30–45°) + external rotation (20°) (Nabext) at three different levels (sourcil “1,” the middle of the femoral head “2,” and lower border of triradiate cartilage “3.” Results At the sourcil level, the femoral nerve was found to be the furthest distance from the anterior acetabulum in the neutral position compared to flexion or neutral plus abduction, external rotation (p < 0.001). For the sciatic nerve, at level 2, hip flexion resulted in a greater distance than in the neutral position (p = 0.001). For level 3, hip flexion caused a decrease in the distance of the sciatic nerve to the acetabulum compared to both neutral positions (N or Nabex) (p = 0.001). Conclusions During a pubic cut of the osteotomy, the femoral nerve moves closer to the anterior acetabulum wall with hip flexion or abduction plus external rotation. During an ischial cut, the sciatic nerve gets closer to the ischium with hip flexion while it moves away from the bone during retroacetabular cut. Level-III Study

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A CT study of the femoral and sciatic nerve periacetabular moving in different hip positions

Işın¹,

Hapa

Kara

et al. 2020

J Orthop Surg Res

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“…The distance between the SN and the lesser trochanter tip was 21 ± 1 mm in the present study, similar to the results of a study of computed tomography (CT) images conducted by Liu et al, 8 reporting a distance of 21.2 ± 5 mm. The authors noted that CT analysis was performed with the pelvis in the neutral position, with the lower limb placed in internal rotation.…”

Section: Discussionsupporting

confidence: 92%

Anatomic implications of lesser trochanterplasty

Hapa¹,

Demirkıran²,

Hüsemoğlu³

et al. 2018

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe aim of this study was to measure the area of iliopsoas tendon attachment and the distance of sciatic nerve, medial circumflex femoral artery (MCFA) and quadratus muscle to lesser trochanter tip, before and after 5, 10, 15 mm depth excision of lesser trochanter.MethodsA total 15 hips of 8 adult male cadavers were evaluated. Distances between lesser trochanter tip, sciatic nerve, the lower edge of quadratus muscle and MCFA; length and width of quadratus muscle insertion; area of iliopsoas muscle and quadratus muscle insertion was measured before and after sequential 5,10 and 15 mm depth trochanterplasties using 5 mm wide burr parallel to the posterior cortex.ResultsEach incremental 5 mm depth bone removal led to significant decrease of tendon area (p=0.001) at each stage. Mean decreases of iliopsoas tendon attachment area with incremental 5 mm burring were 22%±10 with 5 mm, 50%±13 with 10 mm, and 76% ±13 with 15 mm of burring.ConclusionUp to 15 mm lesser trochanter removal did not result in complete detachment of the iliopsoas tendon. Lesser trochanter tip was detected at least 20 mm away from important anatomic structures including quadratus tendon, sciatic nerve, and the medial circumflex femoral artery.

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“…Therefore, the links between chronicity and dosage of GC therapy can lead to increased risk of fractures. 20 …”

Section: Discussionmentioning

confidence: 99%

The Impact of Low-Dose Glucocorticoids on Disease Activity, Bone Mineral Density, Fragility Fractures, and 10-Year Probability of Fractures in Patients with Rheumatoid Arthritis

Cheng

Lai

et al. 2018

Journal of Investigative Medicine

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This study aimed to investigate the effect of low-dose glucocorticoids (LDGs) on disease activity, bone density, and fractures in patients with rheumatoid arthritis (RA). This was an interim analysis of the RA Registry. Demographic data and clinical characteristics, including fracture risk assessment tool, were collected. 25(OH) Vitamin D, bone mineral density (BMD), and intact parathyroid hormone were measured at enrollment. The study group were those who took LDGs (2.5–7.5 mg/day prednisolone or equivalent dose), and the others were included as the control group. A total of 425 participants were enrolled, including 85 (20%) in the control group and 340 (80%) in the study group. The demographics and clinical characteristics were comparable between the two groups. Compared with the control group, the LDGs group had a significantly lower vertebral BMD (L 1–4) (g/cm2), (0.854 vs 0.896, p=0.046), significantly higher rate of previous fractures (103 (30.3%) vs 13 (15.3%), p=0.006), higher 10-year probability of major fractures (14 (15.5) vs 8 (8.6), p<0.0001), and higher 10-year probability of hip fractures (4.4 (8.4) vs 2 (3.9), p<0.0001). Disease activity appeared to be similar in the patients with RA regardless of whether or not they received LDG treatment. However, the patients with RA who received LDG treatment had a lower BMD at the spine (L1–4) and a higher rate of previous fractures that was associated with a significantly higher 10-year probability of fractures than those who did not receive LDG treatment.

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Sciatic nerve course in adult patients with unilateral developmental dysplasia of the hip: implications for hip surgery

Cited by 12 publications

References 28 publications

A CT study of the femoral and sciatic nerve periacetabular moving in different hip positions

A CT study of the femoral and sciatic nerve periacetabular moving in different hip positions

Anatomic implications of lesser trochanterplasty

The Impact of Low-Dose Glucocorticoids on Disease Activity, Bone Mineral Density, Fragility Fractures, and 10-Year Probability of Fractures in Patients with Rheumatoid Arthritis

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