Lateral femoral cutaneous nerve transposition: Renaissance of an old concept in the light of new anatomy

Meralgia paresthetica causes pain in the anterolateral thigh. Most surgical procedures involve nerve transection or decompression. We conducted a cadaveric study to determine the feasibility of lateral femoral cutaneous nerve (LFCN) transposition. In three cadavers, the LFCN was exposed in the thigh and retroperitoneum. The two layers of the LFCN canal superficial and deep to the nerve were opened. The nerve was then mobilized medially away from the ASIS, by cutting the septum medial to sartorius. It was possible to mobilize the nerve for 2 cm medial to the ASIS. The nerve acquired a much straighter course with less tension. A new technique of LFCN transposition is presented here as an anatomical feasibility study. The surgical technique is based on the new understanding of the LFCN canal. Clin. Anat. 30:409–412, 2017. © 2017 Wiley Periodicals, Inc.     

股前皮神经痛的诊断与治疗的局部解剖学基础

目的介绍对股前皮神经痛诊治的经验。方法收集我院门诊2001年10月至2009年9月间在软组织病痛患者中诊断为股前皮神经痛者67例,采用强的松龙25mg加2％利多卡因5mL和生理盐水5mL注射至神经穿出股前部阔筋膜处的方法治疗。结果所有病例皆在注射后10min内止痛。麻药作用后多数表现较轻度疼痛。50例1周后痊愈,10例经第二次注射后痊愈,6例经第三次注射后痊愈。1例经6次注射后仅有改善。结论股前皮神经痛的诊断依据是按其痛觉改变区域与神经的分布区一致决定。采用强的松龙局部注射的疗效较为理想,不失为首选的治疗方法。     

股后皮神经及其主要分支神经痛的诊断与治疗

目的探讨股后皮神经、臀下皮神经及阴唇（囊）后长神经各支神经痛的诊断与治疗。方法收集我院门诊软组织病痛患者中诊断为股后皮神经痛者159例,臀下皮神经痛者40例及阴唇后长神经痛者56例。诊断依据是按疼痛的部位及性质,查体所见的痛觉改变区域与各神经的分布区一致。治疗方法是用强的松龙混悬液1．2mL（30mg）,加2％利多卡因5mL及生理盐水5mL,注射至臀大肌深处及下缘,1周后如不愈,再行第2次注射,少数2周后再行第3次注射。结果所有病例皆在注射后10min内止痛,检查神经分布区内痛觉丧失,数小时后大多数病例再现疼痛。1周后痊愈者共有190例,39例经第2次注射后痊愈,16例经第3次注射后痊愈,10例失访。结论对疑为股后皮神经或其分支臀下皮神经或阴唇（囊）后长神经痛者,经查体确定,排除臀部或腰部可能诱发疼痛的其他病变以后,采取强的松龙注射至臀大肌深处的方法,简便易行,疗效可靠,不失为首选的治疗方法。     

An anatomic study of the lateral femoral cutaneous nerve

Summary In this study, the course of the lateral femoral cutaneous n. was examined bilaterally in 22 cadavers. Seven of these 44 lateral femoral cutaneous nn. showed variations in their course, especially in their number of branches under the inguinal ligament. During operations where the lateral femoral cutaneous n. may be damaged or in its decompression surgery, the nerve is to be found under the inguinal ligament. 1.52±0.84 cm medial to the anterior superior iliac spine. This nerve can be found passing through the inguinal ligament in as many as four branches.

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Une étude anatomique du nerf cutané latéral de la cuisse

Résumé Le trajet du n. cutané latéral de la cuisse a été étudié sur 22 pièces cadavériques des deux côtés. Sept nerfs sur 44 présentaient des variations dans leur trajet, portant essentiellement sur le nombre de branches de division sous le lig. inguinal. Pendant les interventions chirurgicales où le n. cutané latéral de la cuisse peut être endommagé ou lors de sa décompression chirurgicale, il est possible de le retrouver sous le lig. inguinal à 1.52±0.84 cm de l'épine iliaque antérosupérieure. Le nerf ou ses branches de division peuvent passer à travers le lig. inguinal.

     

Variations in the course and microanatomical study of the lateral femoral cutaneous nerve and its clinical importance

The lateral femoral cutaneous nerve (LFCN), a branch from the lumbar plexus, may come to the clinician's or surgeon's attention. We studied this nerve to determine its location and its relationship with neighboring structures around the anterior superior iliac spine (ASIS) and the inguinal ligament (IL). Additionally, cross‐sectional microanatomy of the LFCN at the IL was studied. The LFCN was dissected in 47 lower limbs from formalin‐fixed cadavers. The distances from the ASIS to the point where the LFCN crossed the IL and the lateral border of the sartorius were measured. The distance between the ASIS and the point it pierced the deep fascia was also measured. Twelve nerve specimens at the IL were collected for histological sectioning and were stained with hematoxylin and eosin. On examination of the cross‐sectional area, the nonfascicular area was wider than the fascicular area because of an increased amount of thick collagen fibers. This study may be of help to clinicians managing meralgia paresthetica and may also assist in defining a safe area for surgical intervention on the anterolateral aspect of the thigh. Clin. Anat. 23:978–984, 2010. © 2010 Wiley‐Liss, Inc.     

Examination of the variations of lateral femoral cutaneous nerves: report of two cases

The origins, courses and relations of lateral femoral cutaneous nerves (LFCNs) were examined bilaterally in 28 cadavers, and the variations were observed in two. On the right side of one cadaver, the ventral rami of the first and second lumbar spinal nerves were united and then this nerve was divided into four branches. From medial to lateral, these branches were the obturator nerve, the femoral nerve, the medially located LFCN and the laterally located LFCN. On the left side of another cadaver, there were three LFCNs. All of these nerves pierced the psoas major muscle anterolaterally. Two of these nerves, which pierced the psoas major muscle more proximally than the third, united with each other by a communicating branch anterior to the iliacus muscle. These types of variations are very important, especially in the presence of paresthesias or pain in the anterior thigh, lateral thigh and gluteal region. In these cases, surgeons must always remember the possible variations of the LFCN during surgical procedures in order to prevent injury and the occurrence of meralgia paresthetica.     

股外侧皮神经痛诊治的解剖学基础 (系列报道之九)

目的 介绍股外侧皮神经痛的诊断与局部注射的治疗方法。方法 选择门诊确诊为股外侧皮神经痛的患者40余例，采用强的松龙混悬液加局部麻药局部注射神经通过腹股沟韧带处或穿过该韧带处的治疗方法。结果 所有病例皆在注射后短时止痛，多数病例一周后痊愈，少数病例经2-3次注射后痊愈，极少数失访。结论 对诊断正确的患者，采用强的松龙局部注射法，可获得满意的效果。     

Anatomical variability of the lateral femoral cutaneous nerve: Findings from a surgical series

The lateral femoral cutaneous nerve (LFCN) is a branch of the lumbar plexus and supplies the skin of the lateral thigh region. This entrapment‐compressive syndrome is named meralgia paresthetica or Roth's meralgia and depends, on a vast majority of cases, on the entrapment of the nerve in proximity of the inguinal ligament. Surgical decompression of the nerve is an option when conservative treatments fail and is usually performed through a 3‐cm infrainguinal skin incision. Available data on anatomical variations of the LFCN derive from extensive cadaver dissections and lack many features relevant to the surgeon. This study was conducted to investigate anatomical details of the LFCN at the site of surgery for meralgia paresthetica. We reviewed retrospective data regarding the anatomical features of LFCN from 148 consecutive patients operated on for Roth's meralgia. In the majority of the cases the LFCN was a single trunk, deep to the thigh superficial fascia and to the inguinal ligament and coursing inferior‐lateral to the anterior superior iliac spine. Less frequent findings were early nerve bifurcation, epifascial position, inferior‐medial direction, and exit from the pelvis through an iliac bone canal. In 13 cases (8.8%) the nerve was not found at surgery. Anatomical variations of the LFCN must be considered at the time of surgery to maximize success rates and avoid nerve damage during surgical dissection. Clin. Anat. 22:365–370, 2009. © 2009 Wiley‐Liss, Inc.     

Anatomy of the lateral femoral cutaneous nerve related to inguinal ligament, adjacent bony landmarks, and femoral artery

Lateral femoral cutaneous nerve (LFCN) generally emerges from the pelvis behind the inguinal ligament (IL) to the thigh. Because of its proximity to the anterior superior iliac spine (ASIS) and hip joint, the LFCN is prone to injuries during various procedures. Anatomy of this nerve is highly variable among studies. Moreover, measurement data regarding its branches including the differences between genders and sides are still lacking. This study was, therefore, done to clarify these issues. Eighty-five thighs from 43 cadavers of both genders were dissected at the inguinal region. Distances from each branch of the LFCN to palpable landmarks: the ASIS, pubic tubercle (PT) and femoral artery (FA) were measured along the IL. Up to four branches of the LFCN were found; however, the single trunk was the most common form (>65%). The common site of this pattern on the IL was within 2 cm medial to the ASIS but could be present at over 6 cm. The distances in case of bifurcation were mostly comparable to those of the single trunk. In contrast, the values varied considerably in the cases with three or more branches (three cases). Regarding side and gender, asymmetry in the branching pattern was found in one fourth of specimens. However, only some minor differences between genders or sides in the measurement data were seen. These findings suggest that asymmetry and multiple branches of the LFCN should be concerned. The measurement data are also useful for localizing the LFCN with higher accuracy.     

股外侧皮神经在髂前上棘附近的解剖学和超声观察

目的 感觉异常性股痛(MP)常由股外侧皮神经(LFCN)的机械嵌压引起,通常发生在股外侧皮神经走行至髂前上棘的部位。MP最佳手术治疗方法有待确定,部分原因是LFCN周围筋膜平面的精细结构尚未阐明。本研究的目的是利用生物塑化和超声确定LFCN在髂前上棘附近的筋膜结构。方法 选择11具尸体（6名女性,5名男性, 38～97岁）制作薄层生物塑化切片。对34名健康志愿者（19名女性,15名男性,20～62岁）进行LFCN超声评估。结果 LFCN在腹内斜肌筋膜纤维和髂筋膜之间出骨盆,然后在缝匠肌表面和位于髂前上棘（ASIS）下方的阔筋膜张肌之间走行。在缝匠肌和阔筋膜张肌之间,LFCN走行在独立封闭的筋膜鞘中。结论 LFCN在髂前上棘处位于腹内斜肌腱膜内。LFCN在缝匠肌表面及外侧走行至大腿前外侧区域。超声定位LFCN有助于外科手术。     

前臂内侧皮神经痛的诊断与治疗

目的探讨前臂内侧皮神经痛的诊断与治疗方法。方法回顾性分析我院软组织门诊中明确为前臂内侧皮神经痛的10例患者的临床资料,其治疗均采用25mg强地松龙混悬液加2％利多卡因5mL及生理盐水5mL局部封闭。结果所有病例皆在注射后10rain内止痛或疼痛显著减轻,8例1周后痊愈。2例经第二次封闭后痊愈。结论前臂内侧皮神经痛首选强的松龙局部封闭,疗效肯定值得推广。     

Anatomical study of the lateral femoral cutaneous nerve with special reference to minimally invasive anterior approach for total hip replacement

Background  Lesion of the lateral femoral cutaneous nerve (LFCN) represents the main complication during minimally invasive anterior approach dissection to the hip joint. The aim of this anatomical study was to describe the different presentation features of the LFCN at the thigh and particularly to determine the potential location of damage during minimally invasive anterior approach for total hip replacement. Methods  The LFCN was dissected bilaterally at the thigh under the inguinal ligament in 17 formalin-preserved cadavers. Branching patterns of the nerve were recorded and distances from the LFCN to the anterior superior iliac spine (ASIS) and the anterior margin of the tensor fascia lata (TFL) were measured to clarify skin incision positioning during minimally invasive anterior approach for total hip replacement. Results  The LFCN divided proximal to the inguinal ligament in 13 cases and distal to it in 21 cases. In the distal group the mean distance from the ASIS to the nerve division was 34.5 mm (10–72 mm). The gluteal branch crossed the anterior margin of the TFL 44.5 mm (24–92 mm) distally to the ASIS. In 18 cases the femoral branch did not cross the TFL and was located in the intermuscular space between TFL and sartorius. In the remaining 16 cases, this branch crossed the anterior margin of the TFL 46 mm (27–92 mm) distally to the ASIS. During minimally invasive anterior approach along the anterior border of the TFL, the LFCN was found to be potentially at risk between 27 and 92 mm below the ASIS. We used those informations to describe a map of “danger zones” for the LFCN or its two main branches. Conclusion  According to this study, numerous anatomical variations of the LFCN at the thigh should be considered when performing anterior approach to the hip joint. Different mechanisms of injury during surgery should be considered especially during minimally invasive total hip replacement, such as section of the gluteal or the femoral branch where it crosses the anterior margin of the TFL or stretching of the femoral branch due to retractors positioned into the intermuscular space between sartorius and TFL. According to the map of “danger zones” reported, the author policy consists of positioning the skin incision as lateral and distal to the ASIS as possible.     

糖皮质激素注射治疗皮神经痛2332例分析

目的探讨全身各部位皮神经痛的发生率及糖皮质激素注射治疗的方法。方法回顾性分析2332例皮神经痛患者临床资料。总结各部位皮神经痛的发病率、诊断的理论基础,观察强的松龙混悬液加2%利多卡因局部注射的疗效。结果所有病例注射后数分钟完全止痛,经不完全追踪随访,1860例一周内痊愈;472例经第二次或第三次注射后痊愈。结论皮神经痛发病率高,其病因可能是在神经行程中受到相邻骨膜或穿过筋膜处受到刺激所致,可能与营养状况有关。糖皮质激素局部注射有良好疗效,其机理可能与抑制骨膜或筋膜的成纤维细胞增殖,减轻炎症卡压、消除病因有关。     

臂下外侧皮神经痛诊治的解剖学基础

目的 介绍臂下外侧皮神经痛的诊断与局部注射的治疗方法。方法 选择门诊确诊为臂下外侧皮神经痛的患者5例，采取强的松龙混悬液加局部麻药的局部注射神经通过上臂外侧肌间隔及深筋膜处的方法。结果 所有病情皆在注射后短时间完全止痛，一周后痊愈。结论 对诊断明确的病例，采用强的松龙局部注射法，可以获得满意的疗效。     

腓肠外侧皮神经痛诊治的解剖学基础(系列介绍之十六)

目的 介绍腓肠外侧皮神经痛的诊断与局部注射的治疗方法。方法 选择门诊确诊为腓肠外侧皮神经痛的患者11例，采用强的松龙混悬液加麻药局部注射神经通过胭窝的外下部穿出阔筋膜的局部治疗方法。结果 所有病例皆在注射后短时完全止痛，经1～3次注射后痊愈。结论 对诊断明确的病例，采取强的松龙局部注射法，可以获得满意的疗效。     

Variations in the inferior pelvic pathway of the lateral femoral cutaneous nerve: Implications for laparoscopic hernia repair

Laparoscopic repair of inguinal hernias is gaining acceptance in the repertoire of the general surgeon. However, nerve entrapment sequelae have been reported and appear to be higher with the laparoscopic approach. Contributing factors include pelvic variations in nerve pathways and the use of staples. We examined the pelvic relations of the lateral femoral cutaneous nerve (LFCN) to the anterior superior iliac spine (ASIS) and the iliopubic tract (IPT) because of the high morbidity of entrapment of this nerve, despite its low incidence. The LFCN, ASIS, and IPT were identified and their relationships measured in 48 male and 24 female cadavers ranging in age from 61 to 96 yr. The LFCN was located 1.7 (±1.2) cm medial to the ASIS along the IPT and 1.4 (±0.7) cm posterior (deep) to the IPT at this point, with no significant sex differences. The intrapelvic pathway of the LFCN, including its branches, varied widely so that in 18% of these specimens the LFCN was in either the vertical plane of the ASIS (13%) or in the plane of the IPT (5%). In 11% this nerve was within 1 cm of the ASIS. These data indicate that exclusive use of the ASIS as a guide for staple placement may result in entrapment of this nerve or its branches. © 1996 Wiley-Liss, Inc.     

骨盆手术防止股外侧皮神经损伤的应用解剖学

目的:为骨盆手术防止股外侧皮神经盆内段损伤提供解剖学基础。方法:在25具成人防腐标本上解剖观察股外侧皮神经的起源、行程及分支,测量神经出盆点与髂前上棘中心点的距离。结果:①股外侧皮神经出盆点位置的解剖变异较大,根据神经出盆点与髂前上棘的关系可分为四种类型。②股外侧皮神经72％从腹股沟韧带深面穿出,28％穿行于腹股沟韧带中。穿出点距髂前上棘的距离为(1.02±0.88)cm。③股外侧皮神经穿过腹股沟韧带并被阔筋膜包裹,形成了股外侧皮神经的远侧固定点。结论:(1)腹股沟韧带及阔筋膜对股外侧皮神经的固定作用是骨盆手术损伤股外侧皮神经的解剖学因素。(2)术中神经预防性松解是避免医源性神经损伤的关键。     

带蒂股后皮神经营养血管皮瓣的解剖与临床应用

目的：报道股后皮神经营养血管带蒂皮瓣的解剖特点与临床应用疗效。方法：在10侧经动脉灌注红色乳胶成人新鲜下肢标本上，解剖观测股后皮神经血供及其筋膜皮支的分布范围，设计股后皮神经营养血管岛状皮瓣转移修复腘窝、髋关节周围软组织缺损6例。结果：股后皮神经营养血管主要来源臀下动脉、穿动脉和腘动脉后侧穿支的升皮支，并在股后区形成网状吻合营养股后侧皮肤。皮瓣5例全部成活，1例皮瓣远端少量坏死，换药后愈合。经12～44个月随访，皮瓣无破溃，膝、髋关节功能活动良好。结论：股后皮神经营养血管岛状皮瓣转位是一种修复腘窝、髋关节周围软组织缺损良好的方法。     

股后皮神经及其营养血管皮瓣的应用解剖

目的 :为股后皮神经及其营养血管为蒂的岛状皮瓣提供解剖学依据。方法 :在 3 4侧经动脉灌注红色乳胶的成人标本上 ,解剖观测了股后皮神经及其营养血管的走行、分布、吻合及外径 ,2侧成人新鲜标本墨汁灌注 ,观测营养血管的墨染范围。结果 :股后皮神经由臀大肌下缘中点入股后沿中线下降 ,其主要营养血管上段系臀下动脉的股后皮神经伴行动脉 ,起点外径 0 .7± 0 .2mm ,下段系动脉的升皮支 ,起点外径 0 .7± 0 .2mm ,营养血管沿途发出众多皮支与股后部其他血管的皮支形成网状吻合 ,营养股后部皮肤。结论 :以股后皮神经及其营养血管为蒂可设计切取顺行或逆行岛状皮瓣     

腓肠外侧皮神经营养血管岛状筋膜皮瓣的解剖学基础

目的 :为腓肠外侧皮神经营养血管岛状筋膜皮瓣提供解剖学依据。方法 :采用巨微解剖、全身动脉放射显影及电脑图像分析技术 ,解剖观察了腓肠外侧皮神经及其营养血管的起始、走行、分支与分布情况。结果 :腓肠外侧皮神经于腓骨头上方 ( 7.1± 1.3 )cm ,中线外侧 ( 1.8± 0 .6)cm起自腓总神经 ,分支分布于小腿后外侧上 2 /3部 ,末端与腓肠内侧皮神经相吻合。其营养动脉主要为窝外侧皮动脉 ,于腓骨头水平面上方 ( 4 .6± 2 .3 )cm处发自动脉 ,并于腓骨头上 ( 4 .6± 1.2 )cm ,中线外侧 ( 2 .1± 0 .5 )cm处开始伴行腓肠外侧皮神经下降 ,下端主要与腓动脉穿支吻合 ,形成一营养血管链。结论 :以腓肠外侧皮神经及其营养血管链为蒂可以设计近端或远端蒂岛状筋膜皮瓣。