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  • Title: [Applied anatomy study of posterior approach via sacrectomy for reaching the deep intrapelvic sacral plexus].
    Author: Li F, Wang SF, Li PC, Xue YH.
    Journal: Zhonghua Wai Ke Za Zhi; 2017 Dec 01; 55(12):928-932. PubMed ID: 29224268.
    Abstract:
    Objective: To observe the possibility of posterior approach via sacrectomy for reaching intrapelvic sacral plexus and expose the deep intrapelvic origin of sciatic nerve from sacral plexus in order to perform nerve graft. Methods: Five adult cadaver specimens were used in the study with prone position in May 2012. Cut off the gluteus maximus along the origins and lift to the lateral side, the piriformis was lay beneath. The sciatic nerve and the inferior gluteal nerve pierced from the infrapiriformis foramen in the operative field. Excise the origin of the piriformis via sacrectomy with osteotome and the length and width of the insertion on sacrum were measured. The piriformis was resected and then the sacral nerve roots beneath were exposed. The S2-S4 sacral nerve roots and the deep intrapelvic origin of sciatic nerve from sacral plexus were revealed after carefully dissecting. From July 2012 to June 2016, nine patients with lumbosacral plexus injury were performed surgery through the posterior approach in Department of Hand Surgery, Beijing Jishuitan Hospital.There were 6 male and 3 female patients, with a mean age of 29 years. All patients were diagnosed as upper and lower sacral plexus injury, in one of them combing with contralateral lower sacral plexus injury. The average time from injury to operation was 8.3 months. Results: The length and width of the piriformis insertion on sacrum were (3.44±0.15) cm and (2.42±0.11) cm, respectively. The deep intrapelvic origin of sciatic nerve from sacral plexus in all nine patients can be revealed clearly and there was enough operative space that nerve transfer or graft can be performed through the posterior approach via sacrectomy. The total blood loss during operation was (1 822±1 523) ml. Conclusion: The piriformis and part of sacrum it attached can be resected safely through the posterior approach and the deep intrapelvic sacral plexus and the origin of sciatic nerve can be well exposed. 目的： 探讨经骶骨－臀部后侧联合入路显露盆腔内骶丛神经汇合处及全程显露下骶丛神经的可行性。 方法： 2012年5月在5具成人尸体标本上进行解剖学研究。标本俯卧位，将臀大肌起点全部切断，向外侧掀起肌肉。找到梨状肌，在其下缘显露坐骨神经。向梨状肌起始处追踪至其在骶前孔处附着点，用骨刀将梨状肌起始部连同骶骨附着处一起凿下，测量梨状肌起始部长度(即上下间距)和宽度(即内外间距)。将梨状肌及骨瓣向外侧掀起，显露其深面的S(2)～S(4)神经根(出骶前孔后段)、骶丛神经根在盆腔内汇合处及坐骨神经起始处。收集2012年7月至2016年6月北京积水潭医院手外科收治的9例骶丛神经损伤患者的临床资料。9例患者均经此后侧入路探查盆腔内骶丛神经。男性6例，女性3例，平均年龄29岁，伤后到手术时间平均8.3个月。9例患者均为全骶丛神经损伤型，其中1例合并对侧下骶丛神经损伤。 结果： 尸体标本梨状肌起始部长度为(3.44±0.15)cm，起始部宽度为(2.42±0.11)cm。9例骶丛神经损伤患者均采用此入路完成手术，可显露S(2)～S(4)神经根盆腔内走行段、骶丛神经根汇合处及坐骨神经起始处，并有足够空间实行神经移位、移植等操作，术中出血量(1 822±1 523)ml。 结论： 经骶骨－臀部后侧联合入路，通过将梨状肌在骶骨处附着处凿下，可充分显露盆腔内下骶丛神经、骶丛神经根汇合处及坐骨神经起始处。.
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