Optimal Retractor Insertion Point for Nerve Safety During Total Hip Arthroplasty: An Anatomical Study on the Femoral and Sciatic Nerves in Relation to Hip Motion

• Material Type: 博士論文
• Title: Optimal Retractor Insertion Point for Nerve Safety During Total Hip Arthroplasty: An Anatomical Study on the Femoral and Sciatic Nerves in Relation to Hip Motion
• Author/Editor: Okamoto, Masakazu; Uchihara, Yoshinobu; Saito, Kenichiro; Inagaki, Yusuke; Mahakkanukrauh, Pasuk; Tanaka, Yasuhito
• Author Heading: Okamoto, Masakazu; Uchihara, Yoshinobu; Saito, Kenichiro; Inagaki, Yusuke; Mahakkanukrauh, Pasuk; Tanaka, Yasuhito
• Publication, Distribution, etc.: SAGE Publications
• Publication Date: 2024-07
• Publication Date (W3CDTF): 2024
• Alternative Title: 人工股関節全置換術における神経の安全性のための最適なレトラクター挿入位置：股関節運動に関連する大腿神経および坐骨神経に関する解剖学的研究
• Periodical title: Hip international
• No. or year of volume/issue: 34 4
• Volume: 34
• Issue: 4
• Pages: 459-466
• ISSN (Periodical Title): ISSN : 1120-7000
• Degree grantor/type: 奈良県立医科大学
• Dissertation Number: 甲第928号
• Degree Type: 博士（医学）
• Subject Heading: total hip arthroplasty; nerve injury; retractor insertion; hip motion; optimization
• Target Audience: 一般
• Note (General): 出版タイプ： VoR; type:Thesis; Background Nerve injury is one of the most serious complications of total hip arthroplasty (THA). It is suspected to be result from nerve compression or direct injury caused by an acetabular retractor. The anatomical relationship between the acetabular rim and the femoral and sciatic nerves, including hip motion, has not been investigated. This study aimed to identify the optimal position for retractor insertion during THA to prevent nerve damage. Methods: A total of 28 hip joints from 14 freshly frozen cadavers were used. Using an anterolateral approach, each cadaver was immobilised in the lateral decubitus position and deployed to measure the distance between the nerves and the acetabular rim, while the hip joint was changed to the extension, neutral, and flexion positions. Results: Three femoral nerve was closest to the anterior margin of the acetabulum at 90° and 120° of extension and farthest away at 30° of flexion. The sciatic nerve was closest to the posterior margin of the acetabulum at 90° and 120° of flexion and farthest away at 30° and 150° of extension compared with the other points. Conclusion: To prevent nerve damage during THA, we suggest that the retractor be inserted at the points where the nerves are the farthest away, such as at 30° and 150°. The femoral and sciatic nerves vary in their movements depending on the hip position. Therefore, the safe insertion of a retractor is recommended for hip flexion of the femoral nerve and extension of the sciatic nerve. Additionally, it is important to carefully insert the retractor along the acetabular margin without penetrating the joint capsule. Overall, this study provides valuable insights into the anatomical location and movement of the femoral and sciatic nerves in relation to hip motion and can help inform surgical techniques for safer THA.; 権利情報：Okamoto M, et al. Optimal retractor insertion point for nerve safety during total hip arthroplasty: an anatomical study on the femoral and sciatic nerves in relation to hip motion. Hip International. 2024: 11207000241227399. Copyright © The Author(s) 2024. doi: 10.1177/11207000241227399; identifier:Hip international. 2024 Jul, vol.34, no.4, p.459-466; identifier:1120-7000; identifier:http://ginmu.naramed-u.ac.jp/dspace/handle/10564/4385; identifier:Hip international, 34(4): 459-466
• Source: fulltext; http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/4385/1/01%e7%94%b2928%e6%9c%ac%e6%96%87.pdf; http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/4385/2/02%e7%94%b2928%e6%9c%ac%e6%96%87%e3%81%ae%e8%a6%81%e6%97%a8.pdf; http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/4385/3/03%e7%94%b2928%e5%af%a9%e6%9f%bb%e8%a6%81%e6%97%a8.pdf
• Access Restrictions: インターネット公開
• Related Material (DOI): 10.1177/11207000241227399; https://doi.org/10.1177/11207000241227399
• Periodical Title (NCID): AA11690223; https://ci.nii.ac.jp/ncid/AA11690223
• Data Provider (Database): 国立情報学研究所 : 学術機関リポジトリデータベース（IRDB）（機関リポジトリ）; https://irdb.nii.ac.jp
• Original Data Provider (Database): 奈良県立医科大学 : 奈良県立医科大学機関リポジトリ GINMU