AIM: To study the anatomy(formation, course, relationships and branching pattern) of the obturator nerve in detail.METHODS: The study was based on 500 adult human formalin-embalmed cadavers, 342 males and 158 females....AIM: To study the anatomy(formation, course, relationships and branching pattern) of the obturator nerve in detail.METHODS: The study was based on 500 adult human formalin-embalmed cadavers, 342 males and 158 females. We studied the anatomical formation, course and relationships of the obturator nerve within the lesser pelvis before the obturator canal. Finally, the whole course of the obturator nerve was examined.RESULTS: We found numerous anatomical variations about the formation of the obturator nerve, its division into two main branches, its articular branches, its intrapelvic branches for the periosteum of the pubic bone, and also the number of its muscular divisions and its anatomical relationship to the obturator externus muscle and obturator artery. We found that fibers from the L3 and L4 spinal nerves are standard components of the obturator nerve. The main trunk of the obturator nerve divides into anterior and posterior branches, within the pelvis in 23.30%, within the obturator canal in 52.30% and extrapelvic in 24.35% of cases. The anterior branch of the obturator nerve supplies three muscular branches in 67.10%, two muscular branches in 28.94% and four muscular branches in 3.94% of the cases. The posterior branch of the obturator nerve supplies two muscular branches in 60.52%, three muscularbranches in 19.07%, one muscular branch in 14.47% and four muscular branches in 5.92% of cases.CONCLUSION: We present a gross anatomical study of the human obturator nerve based on a remarkably large number of cases as well as potential clinical applications of our findings.展开更多
We report a patient with severe pulmonary arterial hypertension (PAH) undergoing tibio-talo-calcaneal fusion due to Charcot joint. Despite the advancement in the management of PAH, the risks of anesthesia, surgery, an...We report a patient with severe pulmonary arterial hypertension (PAH) undergoing tibio-talo-calcaneal fusion due to Charcot joint. Despite the advancement in the management of PAH, the risks of anesthesia, surgery, and postoperative morbidity and mortality still remain high. A 46-year-old female was presented with severe PAH and end stage renal disease requiring hemodialysis three times a week. Ultrasound-guided sciatic, femoral, and obturator nerve blocks were performed with 0.5% levobupivacaine 15 ml, 10 ml, and 5 ml, respectively. All the blocks were successful, and the patient underwent uneventful anesthesia and surgery. In addition, the postoperative pain control lasted for 15 h and the patient was discharged on POD 5 without any complications. Therefore, ultrasound-guided sciatic, femoral, and obturator nerve blocks are valuable alternative to the general or neuraxial anesthesia in patients with severe pulmonary hypertension.展开更多
BACKGROUND Cases of obturator nerve impingement(ONI)caused by osteophytes resulting from bone hyperplasia on the sacroiliac articular surface have never been reported.This paper presents such a case in a patient in wh...BACKGROUND Cases of obturator nerve impingement(ONI)caused by osteophytes resulting from bone hyperplasia on the sacroiliac articular surface have never been reported.This paper presents such a case in a patient in whom severe lower limb pain was caused by osteophyte compression of the sacroiliac joint on the obturator nerve.CASE SUMMARY A 65-year-old Asian man presented with severe pain and numbness in his left lower limb,which became aggravated during walking and showed intermittent claudication.The physical examination revealed that the muscle strength of the left lower limb had decreased and that the passive knee flexion test result was positive.Computed tomography(CT)and 3D reconstruction showed a large osteophyte located in the anterior lower part of the left sacroiliac joint.The results of electrophysiological examination showed peripheral neuropathy.A CT-guided obturator nerve block significantly reduced the severity of pain in this patient.According to the above findings,ONI caused by the osteophyte in the sacroiliac joint was diagnosed.This patient underwent an operation to remove the bone spur and symptomatic treatment.After therapy,the patient's pain and numbness were significantly relieved.The last follow-up was performed 6 mo after the operation,and the patient recovered well without other complications,returned to work,and resumed his normal lifestyle.CONCLUSION Osteophytes of the sacroiliac joint can cause ONI,which leads to symptoms including severe radiative pain in the lower limb in patients.The diagnosis and differentiation of this disease should attract the attention of clinicians.Surgical excision of osteophytes should be considered when conservative treatment is not effective.展开更多
文摘AIM: To study the anatomy(formation, course, relationships and branching pattern) of the obturator nerve in detail.METHODS: The study was based on 500 adult human formalin-embalmed cadavers, 342 males and 158 females. We studied the anatomical formation, course and relationships of the obturator nerve within the lesser pelvis before the obturator canal. Finally, the whole course of the obturator nerve was examined.RESULTS: We found numerous anatomical variations about the formation of the obturator nerve, its division into two main branches, its articular branches, its intrapelvic branches for the periosteum of the pubic bone, and also the number of its muscular divisions and its anatomical relationship to the obturator externus muscle and obturator artery. We found that fibers from the L3 and L4 spinal nerves are standard components of the obturator nerve. The main trunk of the obturator nerve divides into anterior and posterior branches, within the pelvis in 23.30%, within the obturator canal in 52.30% and extrapelvic in 24.35% of cases. The anterior branch of the obturator nerve supplies three muscular branches in 67.10%, two muscular branches in 28.94% and four muscular branches in 3.94% of the cases. The posterior branch of the obturator nerve supplies two muscular branches in 60.52%, three muscularbranches in 19.07%, one muscular branch in 14.47% and four muscular branches in 5.92% of cases.CONCLUSION: We present a gross anatomical study of the human obturator nerve based on a remarkably large number of cases as well as potential clinical applications of our findings.
文摘We report a patient with severe pulmonary arterial hypertension (PAH) undergoing tibio-talo-calcaneal fusion due to Charcot joint. Despite the advancement in the management of PAH, the risks of anesthesia, surgery, and postoperative morbidity and mortality still remain high. A 46-year-old female was presented with severe PAH and end stage renal disease requiring hemodialysis three times a week. Ultrasound-guided sciatic, femoral, and obturator nerve blocks were performed with 0.5% levobupivacaine 15 ml, 10 ml, and 5 ml, respectively. All the blocks were successful, and the patient underwent uneventful anesthesia and surgery. In addition, the postoperative pain control lasted for 15 h and the patient was discharged on POD 5 without any complications. Therefore, ultrasound-guided sciatic, femoral, and obturator nerve blocks are valuable alternative to the general or neuraxial anesthesia in patients with severe pulmonary hypertension.
文摘BACKGROUND Cases of obturator nerve impingement(ONI)caused by osteophytes resulting from bone hyperplasia on the sacroiliac articular surface have never been reported.This paper presents such a case in a patient in whom severe lower limb pain was caused by osteophyte compression of the sacroiliac joint on the obturator nerve.CASE SUMMARY A 65-year-old Asian man presented with severe pain and numbness in his left lower limb,which became aggravated during walking and showed intermittent claudication.The physical examination revealed that the muscle strength of the left lower limb had decreased and that the passive knee flexion test result was positive.Computed tomography(CT)and 3D reconstruction showed a large osteophyte located in the anterior lower part of the left sacroiliac joint.The results of electrophysiological examination showed peripheral neuropathy.A CT-guided obturator nerve block significantly reduced the severity of pain in this patient.According to the above findings,ONI caused by the osteophyte in the sacroiliac joint was diagnosed.This patient underwent an operation to remove the bone spur and symptomatic treatment.After therapy,the patient's pain and numbness were significantly relieved.The last follow-up was performed 6 mo after the operation,and the patient recovered well without other complications,returned to work,and resumed his normal lifestyle.CONCLUSION Osteophytes of the sacroiliac joint can cause ONI,which leads to symptoms including severe radiative pain in the lower limb in patients.The diagnosis and differentiation of this disease should attract the attention of clinicians.Surgical excision of osteophytes should be considered when conservative treatment is not effective.
