Postmortem evaluation of neuromuscular damages more extensive than the surgical intervention area after iliac crest bone graft
Postmortem evaluation of neuromuscular damages more extensive than the surgical intervention area after iliac crest bone graft
复制标题
DOI：
10.1007/s00276-020-02657-7
复制
发表时间：
2021-01-05
影响因子：
1.4
通讯作者：
Sato, Fumi
中科院分区：
文献类型：
--
作者：
Kawashima, Tomokazu;Shimizu, Kazuhiko;Sato, Fumi
髂骨移植（自体骨采集的常见部位之一）后可能发生几种并发症。其中，神经系统并发症中的损伤难以定位，因为在个体之间存在差异的类似分布区域中存在多个神经。为了尽量减少这些并发症，传统的临床解剖学研究，使用正常的人尸体估计理论上的神经损伤面积对应的手术干预面积。我们报告一例神经肌肉损伤的93岁妇女谁有髂嵴缺损后，骨移植，根据虚拟和物理解剖与组织学证实。在本研究中，患者被证实有严重的神经肌肉并发症，主要并发症包括疝突出髂动脉缺损。两条髂腹股沟神经中的一条通过髂缺损处用疝囊取出，其远端部分完全受损。离缺损孔较远的髂腹下神经也出现明显的纤维化和脱髓鞘，受腹横肌变性的影响。目前的解剖学研究结果表明，最终的神经肌肉损伤的面积应估计大于传统预测的直接神经损伤的面积，这通常是伴随着手术干预的区域。
Several complications may occur following iliac bone grafting, one of the common sites for autologous bone harvesting. Of these, it is difficult to localize the damage in neurological complications due to the presence of several nerves in a similar distribution area with variations among individuals. To minimize these complications, conventional clinical anatomical studies using normal human cadavers have estimated the theoretical neurological damage area corresponding to the surgical intervention area. We report a case of neuromuscular damage in a 93-year-old woman who had an iliac crest defect after a bone graft, based on the virtual and physical dissections with histological confirmations. In this study, the patient was confirmed to have severe neuromuscular complications with major complications including a hernia protruding through the iliac defect. One of the two ilioinguinal nerves was extracted with the hernia sac through the iliac defect, and its distal part was completely damaged. The iliohypogastric nerve, which was far from the defect foramen, also showed remarkable fibrosis and demyelination, affected by the degeneration of the transversus abdominis muscles. The present anatomical findings show that the area of eventual neuromuscular damage should be estimated to larger than the conventionally predicted area of direct nerve damage, which is usually concomitant with the surgical intervention area.