IJAR.2021.104
Type of Article: Original Research
Volume 9; Issue 2.2 (May 2021)
Page No.: 7970-7975
DOI: https://dx.doi.org/10.16965/ijar.2021.104
Morphometric study of the segmental branches of the splenic artery in human cadaver spleens by dissection method
Nidhi Mangla 1, Sushant Swaroop Das *2, Sabita Mishra 3, Neelam Vasudeva 4.
1 Senior Resident, Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India.
*2 Assistant Professor, Shyam Shah Medical College, Rewa, Madhya Pradesh, India
3 Director Professor and Head, Department of Anatomy, Maulana Azad Medical College, New Delhi, India.
4 Ex-Director Professor, Department of Anatomy, Maulana Azad Medical College, New Delhi, India.
Address for Correspondence: Dr. Sushant Swaroop Das, Assistant Professor, Shyam Shah Medical College, Rewa-486001, Madhya Pradesh, India. E-Mail: susvick@gmail.com
ABSTRACT
Introduction: The superior gluteal nerve (SGN) is a branch of sacral plexus with root value of L4, L5 and S1. It leaves pelvic cavity through greater sciatic foramen along with superior gluteal artery above piriformis. This neurovascular bundle lies in close proximity to superior acetabular rim. Iatrogenic damage to SGN is common during hip arthroplasties and may be primarily attributed to inappropriate placement of retractors. Alarmingly high percentage of affected individuals are stuck with persistent irreversible damage to SGN. Vascular injuries are not as common but pose a challenging scenario to surgeons. Hence in both situations prevention is of supreme importance. Precise knowledge of course and relation of superior gluteal neurovascular bundle (SGNVB) to clinically useful landmarks such as the superior rim of acetabulum is desired. With an aim to provide baseline data for the Indian population we conducted this study.
Material and methods: 200 dry adult Indian hip bones {Left side -109(male:66, female:43); Right side-91(male:66, female:43)} were photographed in anatomical position. Two lines- line A and line B were drawn. Line A corresponded to a horizontal passing through the anterior inferior iliac spine (AIIS) and roof of GSN while line B passed tangentially through the highest point on the acetabular rim parallel to line A. The vertical distance (white line) between the 2 lines was measured (Fig.2) was measured using Image J software.
Results: The mean distance calculated was 0.62 ± 0.16 cm (0.68 ± 0.38 cm in right hip bones and 0.60 ± 0.30 cm in left side hip bones). The difference between the two sides and the two genders were compared and found to be statistically non- significant.
Conclusion: A safe zone of 0.5 to 0.7 cm beyond the superior acetabular rim should be considered during surgeries around hip joint. The safe zone can be easily measured by the surgeons intraoperatively and be used as a guide to careful positioning of the retractors while performing surgeries around the hip joint. Better localization of SGNVB using the anatomic landmark defined in this study may be used to decrease surgical morbidity.
Key words: Superior Gluteal, Acetabulum, Hip Joint, Total hip arthroplasty, Safe Zone.
REFERENCES
[1]. S. Standring. Gray’s anatomy-The anatomical basis of clinical practice. 41st ed. London: Elsevier; 2016. Pelvic Girdle and Lower Limb; p.1367 and 1374.
[2]. Brown GD, Swanson EA, Nercessian OA. Neurologic injuries after total hip arthroplasty. Am J Orthop (Belle Mead NJ). 2008;37:191–7.
[3]. Wang TI, Chen HY, Tsai CH, Hsu HC, Lin TL. Distances between bony landmarks and adjacent nerves: anatomical factors that may influence retractor placement in total hip replacement surgery. J Orthop Surg Res. 2016 Mar 16;11:31.
[4]. Ick-Hwan Yang. Neurovascular Injury in Hip Arthroplasty .Hip Pelvis.2014 Jun; 26(2): 74–78.
[5]. Kenny P, O’Brien CP, Synnott K, et al. Damage to the superior gluteal nerve after two different approaches to the hip. J Bone Joint Surg Br. 1999;81:979–81.
[6]. Weale AE, Newman P, Ferguson IT, Bannister GC. Nerve injury after posterior and direct lateral approaches for hip replacement. A clinical and electrophysiological study. J Bone Joint Surg Br. 1996 Nov;78(6):899-902.
[7]. Abitbol JJ, Gendron D, Laurin CA, et al. Gluteal nerve damage following total hip arthroplasty. A prospective analysis. J Arthroplasty. 1990;5:319–22.
[8]. Schmalzried TP, Amstutz HC, Dorey FJ. Nerve palsy associated with total hip replacement. Risk factors and prognosis. J Bone Joint Surg Am. 1991;73:1074-80.
[9]. Oldenburg M, Muller RT. The frequency, prognosis and significance of nerve injuries in total hip arthroplasty. Int Orthop. 1997;21:1–3.
[10]. Annu Babu, Amit Gupta, Pawan Sharma, Piyush Ranjan, Atin Kumar. Blunt traumatic superior gluteal artery pseudoaneurysm presenting as gluteal hematoma without bony injury: A rare case report. Chin J Traumatol. 2016 Aug; 19(4): 244–246.
[11]. Suk Kang, Phil Hyun Chung, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Gyeong Soo Eum. Superior Gluteal Artery Injury during Percutaneous Iliosacral Screw Fixation: A Case Report.Hip Pelvis. 2015 Mar; 27(1): 57–62.
[12]. Claudia De Gregorio, Flavia Spalla, Andrea Padricelli, Donatella Narese, Umberto Bracale, Doriana Ferrara, Luca del Guercio, Umberto Marcello Bracale. The Endovascular Management of an Iatrogenic Superior Gluteal Artery Rupture Following Bone Marrow Biopsy. Intern Med. 2017 Oct 1; 56(19): 2639–2643.
[13]. Brown JJ, Greene FL, McMillin RD. Vascular injuries associated with pelvic fractures. Am Surg. 1984 Mar;50(3):150-4.
[14]. Ramesh M, O’Byrne JM, McCarthy N, Jarvis A,Mahalingham K, Cashman WF. Damage to the superior gluteal nerve after the Hardinge approach to the hip. J Bone Joint Surg Br. 1996;78:903-6.
[15]. Ince A, Kemper M, Waschke J, Hendrich C. Minimally invasive anterolateral approach to the hip: risk to the superior gluteal nerve.Acta Orthop. 2007 Feb;78(1):86-9.
[16]. Apaydin N, Kendir S, Loukas M, Tubbs RS, Bozkurt M. Surgical anatomy of the superior gluteal nerve and landmarks for its localization during minimally invasive approaches to the hip. Clin Anat. 2013 Jul;26(5):614-20.
[17]. Ray B, D’Souza AS, Saxena A, Nayak D, Sushma RK, Shetty P, Pugazhendi B. Morphology of the superior gluteal nerve: a study in adult human cadavers. Bratisl Lek Listy. 2013;114(7):409-12.
[18]. Grob K, Manestar M, Ackland T, Filgueira L, Kuster MS. Potential Risk to the Superior Gluteal Nerve During the Anterior Approach to the Hip Joint: An Anatomical Study. J Bone Joint Surg Am. 2015 Sep 2;97(17):1426-31.
[19]. Jacobs LG, Buxton RA. The course of the superior gluteal nerve in the lateral approach to the hip. J Bone Joint Surg Am. 1989;71:1239–43.
[20]. Bos JC, Stoeckart R, Klooswijk AI, et al. The surgical anatomy of the superior gluteal nerve and anatomical radiologic bases of the direct lateral approach to the hip. Surg Radiol Anat. 1994;16:253–8.
[21]. Baker AS, Bitounis VC. Abductor function after total hip replacement: an electromyographic and clinical review. J Bone Joint Surg [Br] 1985;71-B:47-50.
[22]. Eksioglu F, Uslu M, Gudemez E, et al. Reliability of the safe area for the superior gluteal nerve. Clin Orthop Relat Res. 2003;412:111–6.
[23]. Lucian B Solomon, Donald W. Howie ,Maciej Henneberg. The Variability of the Volume of Os Coxae and Linear Pelvic Morphometry. Considerations for Total Hip Arthroplasty. Int J Morphol.2012;30(3):1042-9.
[24]. Guy p, Al-Otaibi M, Harvey EJ, Helmy N. The ‘safe zone’ for extra-articular screw placement during intra-pelvic acetabular surgery. J Orthop Trauma.2010 May;24(5):279-83.
[25]. Amar E, Druckmann I, Flusser G, Safran MR, SalaiM, Rath E. The anterior inferior iliac spine: size, position, and location. An anthropometric and sex survey. Arthroscopy. 2013 May;29(5):874-81.
