RESUMO
SUMMARY: To determine the morphometric landmarks and anatomical variants relevant to the arthroscopic approach to the deep gluteal space. Twenty deep gluteal spaces from cadaveric specimens were dissected. The anatomical variants of the sciatic nerve (SN) were determined according to the Beaton and Anson classification. A morphometric study of the distances in the subgluteal space was carried out to define the anatomical references to achieve a safe arthroscopic approach for piriformis syndrome [GT-SN=Distance from greater trochanter (GT) to SN emergence; GT-IT=Distance from GT to ischial tuberosity (IT); GT-IGA=distance from GT to inferior gluteal artery (IGA) emergence; IT-SN=distance from IT to SN emergence; IT-IGA=distance from IT to IGA]. The SN showed the most frequent anatomical pattern with an undivided nerve coming out of the pelvis below the piriformis muscle (Beaton type A) in 16 specimens (80 %). The common peroneal nerve emergence in the subgluteal space through the piriformis muscle (PM) with the tibial nerve being located at the lower margin of the piriformis muscle (Beaton type B) was observed in 4 specimens (20 %). The morphometric measurements of the surgical area of study were: GT-SN=7.23 cm (±8.3); GT-IT=8.56 cm (±0.1); GT-IGA=8.46 cm (±0.97); IT-SN=5.28 cm (±0.73), IT- IGA=5.47 cm (±0.74). When planning surgery for the deep gluteal syndrome in adult patients, the fact that the emergence of the SN in the subgluteal space is approximately 7 cm from the greater trochanter and 5 cm from the ischial tuberosity must be considered.
RESUMEN: El objetivo del estudio fue determinar referentes morfométricos y variantes anatómicas relevantes en el abordaje artroscópico del espació subglúteo. Se disecaron veinte regiones glúteas procedentes de cadáver. Las variaciones anatómicas del nervio ciático (SN) se determinaron de acuerdo con la clasificación de Beaton y Anson. Se llevó a cabo un estudio morfométrico de distancias en el espacio subglúteo, con objeto de determinar referencias que permitan un abordaje artroscópico seguro del sindrome piriforme [GT-SN= distancia trocánter mayor (GT) a la emergencia del nervio ciático (SN); GT-IT= distancia GT a la tuberosidad isquiática (IT); GT-IGA= distancia GT a la emergen- cia de la arteria glútea inferior (IGA); IT-SN= distancia IT a la emergencia del SN; IT-IGA= distancia IT a la IGA]. El patrón más frecuente del SN fue su emergencia no dividida por el margen inferior del músculo piriforme (tipo A Beaton) en 16 especímenes (80 %). La salida del nervio fibular común a través del músculo piriforme (PM) con el nervio tibial localizado en el margen inferior del PM (tipo B Beaton) se observó en 4 especímenes (20 %). Las medidas en el área quirúrgica de estudio fueron: GT-SN= 7,23 cm ± 8,3; GT-IT= 8,56 cm ± 0,1; GT-IGA= 8,46 cm ± 0,97; IT-SN= 5,28 cm ± 0,73 IT-IGA= 5,47 cm ± 0,74. En la cirugía del síndrome glúteo profundo en adultos, debe considerarse que la sa- lida del SN hacia el espacio subglúteo tiene lugar aproximadamente a 7 cm del GT y a 5 cm de la IT.
Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Artroscopia , Nádegas/anatomia & histologia , Pontos de Referência Anatômicos , Nervo Isquiático/anatomia & histologia , Nádegas/inervação , Cadáver , Variação AnatômicaRESUMO
BACKGROUND: Hip arthroscopy has become an increasingly used technique in orthopedic surgery; the learning curve of this procedure has been discussed recently. The purpose of this study is to assess the learning curve of arthroscopic hip surgery using the complications occurred during the surgery as an objective parameter to measure the outcomes. METHODS: Hip arthroscopic surgeries were performed. Patients were divided into two groups, group A corresponded to the learning curve of the first surgeon and group B includes the remaining surgeries. The demographic, surgical, functional and complications data for both groups were collected. RESULTS: Group A: 30 patients were included, the traction time during surgery was a mean of 75 minutes (range: 45-120). Five complications occurred (16.6%), all of them related to transient neuropraxia of the pudendal nerve. Group B: 67 patients were included, traction time during surgery was a mean of 63 minutes (range: 35-90), 2 complications (2.9%) occurred. CONCLUSIONS: Before performing hip arthroscopy it is necessary to have knowledge of arthroscopic surgery and the regional anatomy, and to have received specific training, given that this technique involves a long learning curve.