Transferring superior gluteal nerve to pudendal nerve in reconstructing functional impairment in simple conus medullaris or pudendal nerve injury

摘要

Objective: 1Department of Anatomy, College of Basic Medical Sciences, Second Military Medical University, Shanghai 200433, China 2Department of Orthopedic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China Abstract Objective: To study the anatomical basis of transferring the superior gluteal nerve to the pudendal nerve in reconstructing the functional impairment in simple conus medullaris or pudendal nerve injury. Methods: Superior gluteal nerve and pudendal nerve were observed and measured by the gross and microsurgical anatomical methods in 62 sides of 31 adult cadavers. Results: Superior gluteal nerve came out of the superior foreman of piriformis as 1 to 4 branches(29.03%,56.45%,12.90% and 1.61% respectively) and the pelvic-leaving points were mainly in the middle 1/3(85.48%) of the line from the posterior superior iliac spine to the ischial tuberosity. The length of the inferior branch of the superior gluteal nerve was more than 5 cm, and the distance between the pelvic-leaving points of the superior gluteal nerve and pudandal nerve was about 4 cm only. The pudendal nerve left the pelvis mainly in the middle 1/3(48.39%) of the line from the posterior superior iliac spine to the ischial tuberosity,or at the junction of its inferior-middle 1/3(46.77%). In clinic, we have successfully made the operation transferring the superior gluteal nerve to the pudendal nerve in 3 patients suffered from the injury of conus medullaris. Conclusion: Distance between the pelvic-leaving points of the superior gluteal nerve and the pudendal nerve is close, so the inferior branch of the gluteal nerve can be anastomosed with the pudendal nerve directly. Transferring the superior gluteal nerve with higher spinal segemental origin to the pudendal nerve of a lower spinal segemental origin is practical and easy.