A CT study of the femoral and sciatic nerve periacetabular moving in different hip positions
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(2020) 15:404
RESEARCH ARTICLE
Open Access
A CT study of the femoral and sciatic nerve periacetabular moving in different hip positions Yagmur Isin1* , Onur Hapa2, Yavuz Selim Kara2, Ali Ihsan Kilic2 and Ali Balcı3
Abstract 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 Keywords: Neurovascular injury, Hip, Periacetabular osteotomy, Sciatic nerve location
Introduction Bernese periacetabular osteotomy (PAO) is the main treatment choice for residual acetabular dysplasia [1]. In classical PAO that described by Ganz, SmithPeterson approach is used [1]. The first nerve that must be protected is the lateral femoral cutaneous nerve. By lateral incision of the tensor fascia lata, * Correspondence: [email protected] 1 Department of Orthopedic Surgery, Kurtalan State Hospital, 56500 Siirt, Turkey Full list of author information is available at the end of the article
the lateral cutaneous nerve can be protected. After exposing bone surfaces, there are 3 main bone cuts. The first one is the ischial cut, and during this cut, the hip is placed in 45° of flexion and is slightly adducted [1]. The sciatic nerve is under the risk of damage, and to protect the sciatic nerve, care should be taken not to drive the chisel too deeply through the lateral cortex, especially with the hip flexed and adducted [1]. The second cut is the pubic cut, and for this cut, the hip should be slightly flexed and adducted and the iliopsoas and femoral
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