臀下神经转位阴部神经的应用解剖

Applied anatomy of transferring inferior gluteal nerve to pudendal nerve

目的:为重建单纯脊髓圆锥或阴部神经损伤后的会阴部功能提供解剖学基础。方法:对成人尸体的臀下神经和阴部神经进行了观测。结果:臀下神经以1支(45.00％)或2支(46.67％)从盆腔穿出为多,其中85.00％穿梨状肌下孔;其穿出点的位置主要在髂后上棘与坐骨结节连线的中1/3(50.00％)或上、中1/3交界处(48.33％)。神经干的长大于3 cm,与阴部神经穿出处相距仅约2 cm。阴部神经出盆处主要在髂后上棘与坐骨结节连线中1/3(46.67％)或中、下1/3交界(50.00％)。结论:两神经出盆处位置接近,臀下神经的长度足以直接与阴部神经缝接,用脊髓起源节段高的臀下神经转位脊髓起源节段低的阴部神经,切实易行。

Objective : To explore the anatomic basis of transferring the inferior gluteal nerve to the pudendal nerve in reconstructing the functional impairment during simple spinal cone or pudendal nerve injury. Methods :The inferior gluteal nerves and pudendal nerves were observed and measured in 60 sides of adult cadavers. Results : There were 85.00% inferior gluteal nerve penetrating from the inferior foramen of piriformis as 1 to 4 branches (45.00% ,46.67% ,6.67% ,and 1.67% respectively). The inferior gluteal nerve penetrated from the pelvis mainly in the middle 1/3 (50. 00%) of the line from the posterior superior iliac spine to the ischial tuberosity or at the junction of its superior-middle 1/3 (48.33%). The length of the inferior gluteal nerve or its main branches was more than 3 cm, and the distance between the penetrating points of it and the pudandal nerve was about 2 cm only. The pudandal nerve penetrated from the pelvis mainly in the middle 1/3(46.67%) of the line from the posterior superior iliac spine to the ischial tuberosity or at the junction of its superior-middle 1/3(50.00%). Conclusion : The distance between the penetrating points of the inferior gluteal nerve or its main branches and the pudendal nerve is close, so the inferior gluteal nerve or its main branches can be anastomosed with the pudendal nerve directly. Transferring the inferior gluteal nerve with a higher spinal segemental origin to the pudendal nerve with a lower spinal segemental origin is practical and easy.