Distances between bony landmarks and adjacent nerves: anatomical factors that may influence retractor placement in total
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RESEARCH ARTICLE
Open Access
Distances between bony landmarks and adjacent nerves: anatomical factors that may influence retractor placement in total hip replacement surgery Ta-I Wang1, Hui-Yi Chen2, Chun-Hao Tsai1,3, Horng-Chaung Hsu1,3 and Tsung-Li Lin1*
Abstract Background: Retractor placement is a leading cause of intraoperative nerve injury during total hip replacement (THR) surgery. The sciatic nerve, femoral nerve, and superior gluteal nerve are most commonly affected. This study aimed to identify the distances from bony landmarks in the hip to the adjacent nerves on magnetic resonance imaging (MRI) and the associations between anatomical factors and these distances that would guide the placement of retractors during THR surgery, in order to minimize the risk of nerve injury. Methods: We reviewed hip MRIs of 263 adults and recorded the distances from (1) the anterior acetabular rim to the femoral nerve; (2) the superior acetabular rim to the superior gluteal nerve; (3) the posterior acetabular rim to the sciatic nerve; and (4) the greater trochanter to the sciatic nerve. The effects of anatomical factors (i.e., gender, age, body height, body mass index (BMI), pelvic width, and acetabular version and morphology) on these distances were analyzed. Results: Distances from bony landmarks to adjacent nerves (in cm) were 2.06 ± 0.44, 2.23 ± 0.28, 1.94 ± 0.81, and 4.83 ± 0.26 for the anterior acetabular rim, superior acetabular rim, posterior acetabular rim, and greater trochanter, respectively, and were shorter in women than in men (P < 0.001). Multivariate analysis identified body height as the most influential factor (P < 0.001). Linear regression demonstrated a strong positive linear correlation between body height and these distances (Pearson’s r = 0.808, 0.823, 0.818, and 0.792, respectively (P < 0.001)). Conclusions: The distances from bony landmarks to adjacent nerves provide useful information for placing retractors without causing nerve injury during THR surgery. Shorter patients will have shorter distances from bony landmarks to adjacent nerves, prompting more careful placement of retractors. Keywords: Distances, Bony landmarks, Adjacent nerves, Magnetic resonance imaging, Total hip replacement, Body height
Background The incidence of nerve injury in primary total hip replacement (THR) surgery ranges from 0.17 to 3.7 % [1– 4]. Around 80 % of patients who sustain a THR-related nerve injury have persistent neurologic dysfunction, including paraesthesia, neuropathic pain, or motor weakness [5]. Such injuries have severe effects on patients’ prognoses and reduce their quality of life [6]. * Correspondence: [email protected] 1 Department of Orthopedics, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan Full list of author information is available at the end of the article
The most commonly identifiable causes of intraoperative nerve injuries were leg lengthening, heat generated during polymerization, direct nerve encasement, trauma caused by instrumentation, or inapp
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