臀肌悬带解剖学测量及其临床意义

目的测量臀肌悬带的相关解剖学参数,为国人解剖学数据提供资料,同时为临床通过切除臀肌悬带降低坐骨神经麻痹发生率提供解剖学依据。方法选择国人成人尸体下肢标本24例,测量其臀肌悬带以及其与坐骨神经、第1穿动脉、股骨大转子尖和坐骨结节的关系。结果臀肌悬带的长度为(8.68±0.80)cm;悬带的近侧端和股骨大转子尖之间的距离为(6.57±0.92)cm;坐骨结节后尖的臀大肌纤维和悬带近侧端距离为(5.56±0.71)cm;悬带近侧2/3末端与坐骨结节的连线与坐骨神经夹角为(42.2±5.4)°;坐骨神经外侧缘与悬带近、远侧端之间的最小横向距离分别为(2.93±0.56)cm和(2.30±0.42)cm;大转子尖和第1穿动脉的距离为(10.84±0.54)cm;大转子尖和第1穿动脉升支的距离为(8.77±0.58)cm;悬带近端到第1穿动脉的距离为(3.84±0.53)cm;悬带近端到第1穿动脉升支的距离更近,为(1.78±0.93)cm。结论切断悬带近侧端约6cm就足以释放坐骨神经压力而不必完全切除悬带。第1穿动脉特别是其升支与臀肌悬带极为接近,极易受损,解剖分离后者与周围结构时,应极为谨慎。

Anatomical evaluation and clinical significance of the gluteal sling

Objective To study anatomy of the gluteal slings and their relationship to adjacent structures,in order to provide the anatomical basis of gluteal sling to avoid its compression on the sciatic nerve. Methods The gluteal sling was examined in 24 sides of 12 adult cadavers. Its relation with the sciatic nerve, first perforating artery, the tip of greater trochanter and the ischial tuberosity were evaluated. Results The mean length of the gluteal sling was measured as（8.68±0.80）cm. The mean distance of the tip of the greater trochanter to the proximal edge of the gluteal sling was（6.57±0.92）cm。The distance between the fibers of the gluteus maximus which passed just inferior to the distal tip of the ischial tuberosity and the proximal edge of the gluteal sling was measured as（5.56±0.71）cm. The angle between the sciatic nerve and the line that intersected the IT and the distal aspect of the proximal 2/3 of the gluteal sling was (42.2±5.4)°。The distance of the sciatic nerve to the proximal edge of the gluteal sling was measured as（2.93±0.56）cm and to the distal edge of the gluteal sling was (2.30±0.42)cm. The mean distance between the tip of the greater trochanter and first perforating artery was (10.84±0.54)cm. The ascending branch of the first perforating artery was closer to the tip of the greater trochanter being (8.77±0.58)cm. The distance of the proximal edge of the gluteal sling to the first perforating artery was (3.84±0.53)cm. The corresponding distance to its ascending branch was closer, being(1.78±0.93) cm. Conclusion Theoretically, it is enough to release about 6cm of the gluteal sling from the proximal to avoid its compression on the sciatic nerve. The first perforating artery，particularly, the ascending branch of the first perforating artery was under risk of injury if it is not dissected carefully from the surrounding structures.