Clinical analysis of 11 cases of iliopsoas muscle hematoma compressing lumbar plexus nerve / 中国基层医药

Objective:To investigate the etiology, clinical manifestations, treatment methods, and prognosis of patients with iliopsoas muscle hematoma compressing the lumbar plexus.Methods:The clinical data of 11 cases of iliopsoas muscle hematoma oppressing the lumbar plexus nerve admitted to The Affiliated Hospital of Southwest Medical University between March 2014 and May 2018 were analyzed.Results:Eleven patients, consisting of 10 men and 1 woman, aged (36.36 ± 6.74) years were analyzed. Causes of iliopsoas muscle hematoma oppressing the lumbar plexus nerve included coagulation abnormality ( n = 8) and trauma ( n = 3). Iliopsoas muscle hematoma occurred on the left side in 7 cases and on the right side in 4 cases. Among them, 11 cases had bleeding in the middle area, 8 cases in the lower area, and 2 cases in the upper area. The involved lumbar plexus nerve included the femoral nerve ( n = 11), lateral femoral cutaneous nerve ( n = 6), and obturator nerve ( n = 2). Eleven cases underwent causative treatment ( n = 11). Three-month follow-up results showed that the hematomas were completely absorbed in 11 cases, and the bone and joint activities were normal. The sensory and motor functions were restored in 10 cases. The sensory function was restored, but the recovery of motor function was poor in 1 patient. All 11 cases returned to normal after 1 year. Conclusion:The main causes of iliopsoas muscle hematoma are coagulation dysfunction and trauma. The femoral nerve and lateral femoral cutaneous nerve in the lumbar plexus are easily affected, which can cause lower limb sensory and motor disorders. As for iliopsoas muscle hematoma caused by coagulation abnormality, coagulation factors should be supplemented to correct coagulation function. As for iliopsoas muscle hematoma caused by trauma, early surgical treatment should be performed to relieve nerve compression. Timely treatment of iliopsoas muscle hematoma can generally acquire a good prognosis.

The application of pelvic unlocking reduction frame for the treatment of old Denis I or II sacral fractures combined with sacral plexus nerve injury / 中华骨科杂志

Objective:To investigate the clinical effect assistant with pelvic unlocking reduction frame for the treatment of old Denis I or II sacral fractures combined with sacral plexus nerve injury.Methods:From January 2013 to October 2020, 37 patients diagnosed with old sacral fractures with sacral plexus nerve injury which Gibbons classification was grade III were divided into the use group and the non-use group according to whether assisted with pelvic unlocking reduction frame. Eighteen patients (11 males, 7 females, mean age 38±6.4, range from 13-56) were selected into the use group and nineteen patients (14 males, 5 females, mean age 42±10.7, range 19-59) were selected into the non-use group. The three-dimensional (3D) pelvic model (1∶1) was printed before operation. The operation time, intraoperative bleeding, Matta score, visual analogue scale (VAS), Majeed score and gibbons sacral nerve injury grade of the two groups were compared. The healing time and complications of each group was recorded.Results:The average operation time of the use group and the non-use group was 121.0±16.2 min and 182.6±16.2 min, respectively, with significant difference ( t=11.54, P<0.001). The mean operative bleeding was 686±382 ml of the use group and 963±348 ml of the non-use group ( t=2.38, P=0.003). The quality of fracture reduction was evaluated according to Matta scoring standard: the excellent and good rate of the use group was 94% (17/18), and that of the non-use group was 68% (13/19) ( P=0.039). The curative effect was evaluated according to the Majeed score: the use group was 88.72±7.03 points, and that of the non-use group was 72.00±9.75 points ( t=5.96, P<0.001) at 1 year post-operative. One year after operation, the VAS scale of the use group was 0.83±0.71 points, and that of the non-use group was 1.00±0.82 points ( t=0.66, P=0.512). According to Gibbons classification, 15 patients were grade I, 1 patient was grade II and 2 patients were grade III in the use group and 11 patients were grade I, 3 patients were grade II and 5 patients were grade III in the non-use group one year after operation ( Z=-1.04, P=0.401). One patient in the use group presented rupture of plate without symptoms. In the non-use group, 1 case with internal iliac vein rupture which treated with gelatin sponge and no obvious bleeding after operation. 4 cases with unequal length of lower limbs, walking claudication. The complication rate of the use group was 6% (1/18), and that of the non-use group was 26% (5/19) ( P=0.042) . Conclusion:The lateral rectus abdominis approach combined with pelvic unlocking reduction frame can reduce the operation time and bleeding, improve the fracture reduction in the treatment of old Denis type I and II sacral fractures with sacral plexus injury.

Application of 3D image fusion technique of enhanced CT and magnetic resonance neurography on pelvic fractures with lumbosacral plexus injury / 中华骨科杂志

Objective:To investigate the application of three-dimensional (3D) image fusion technique of pelvic enhanced CT and magnetic resonance neurography (MRN) on the patients of pelvic fractures with lumbosacral plexus injury.Methods:From January 2019 to December 2020, 15 patients (11 males, 4 females, mean age 26.67±11.34 of pelvic fracture (AO classification C1.3 of 11 cases, C2 of 2 cases, C3 of 2 cases) with lumbosacral plexus injury underwent 3D image fusion of pelvic enhanced CT and MRN. All patients exhibited lower limb nerve dysfunction after injury. The preoperative muscle strength were evaluated by British Medical Research Council (BMRC) criteria: grade 0 in 2 cases, grade 1 in 5, grade 2 in 7 and grade 3 in 1. Physical examination and enhanced CT combined with MRN 3D image fusion technology were used to accurately determine the injury site of lumbosacral plexus nerve, fracture displacement, and the direction of blood vessels and ureters, and develop corresponding surgical plans. The neurological functions were measured in post-operation follow-up.Results:All 15 operations were successfully completed and the site of lumbosacral plexus injury during operation was consistent with preoperative fusion image, and inconsistency of injury characteristic in 4 patients (4/15, 27%). Among the 6 cases of laparoscopic surgery, 2 cases were changed to open surgery because of the difficulty of nerve decompression. The average time of 4 cases of laparoscopic surgery was 116.27±26.46 min and intraoperative blood loss was 102.50±79.32 ml. The average time of 11 cases of open operation was 123.64±38.28 min, and intraoperative blood loss was 713.64±393.12 ml. For the opening operations, 9 cases were successfully decompressed, and nerve disruption was observed in 2 patients. All 15 patients were followed up. The average follow-up time was 9.33±2.19 months. The radial bony healing was observed in each case at the end of follow-up, mean healing time was 5.03±1.04 months (range, 3-6 months). In addition, patients' muscle strength recovered, 8 cases of grade 5, 3 cases of grade 4, 1 case of grade 3, 1 case of grade 2, and 2 cases of grade 0 after surgery. The difference was statistically significant ( Z=3.27, P<0.001). On the other hand, in sensory function assessment, there were 8 cases of grade S5, 1 case of grade S4, 3 cases of grade S3, 1 case of grade S2 and 2 cases of grade S0 after surgery. Conclusion:3D image fusion of enhanced CT and MRN can accurately locate and characterize pelvic fractures combined with lumbosacral plexus injury before surgery, accurately guide the formulation of surgical plan, and reduce surgical trauma and related complications.

Origin and distribution of the lumbosacral plexus anatomy in van cats / Origen y distribución de la anatomía del plexo lumbosacro en gatos van

SUMMARY: The innervation of the pelvic limbs of the Van cat is investigated in this research. The origins of the nerves, the innervated muscles and nerve diameters were shown in a table. Five cat cadavers were used in the study. The pudendal nerve originated from the S1-S2 spinal nerves. The femoral nerve consisted of the ventral branches of the 5th and 6th lumbar nerves in 4 cats The ischiatic nerve was composed of the 6th and 7th lumbar (L6-L7) and S1 spinal nerves in all cadavers. The ischiatic nerve was the thickest branch of sacral plexus (the average diameter on the right side was 3.31 ± 0.27 mm and the average diameter on the left side was 3.28 ± 0.29 mm). The lumbosacral plexus was formed by the ventral branches of the L4-S3 spinal nerves. N.genitofemoralis consisted of only the ventral branches of L4 in all cadavers. N. femoralis did not give rise to a branch to the m. iliopsoas. N.plantaris lateralis was found to give a branch to the 3th finger. The quadriceps femoris muscles did not take any branches from either the ischiadicus nerve or the pudendal nerve. The obturator nerve did not receive any branches from the L4 spinal nerves. There was no branch to the skin from the caudal gluteal nerve. The thinnest nerve was the pudendal nerve. Due to the scarcity of studies on the lumbosacral plexus of cats, it is thought that this study will complete a gap in the field of veterinary anatomy.

RESUMEN: En esta investigación se estudió la inervación de los miembros pélvicos del gato Van. Los orígenes de los nervios, los músculos inervados y los diámetros de los nervios son mostrados en una tabla. En el estudio se utilizaron cinco cadáveres de gatos. En cuatro gatosel nervio pudendo se originaba a partir de los nervios espinales S1-S2. El nervio femoral consistió en los ramos ventrales de los nervios lumbares quinto y sexto. El nervio isquiático estaba compuesto por los nervios espinales sexto y séptimo lumbar (L6-L7) y S1 en todos los cadáveres. El nervio isquiático era el ramo más grueso del plexo sacro (el diámetro medio del lado derecho medía de 3,31 ± 0,27 mm y el diámetro medio izquierdo 3,28 ± 0,29 mm). El plexo lumbosacro estaba formado por los ramos ventrales de los nervios espinales L4-S3. N. genitofemoralis constaba solo de las ramas ventrales de L4 en todos los cadáveres. N. femoralis no dio lugar a un ramo a la m. iliopsoas. Los músculos del cuádriceps femoral no tomaron ningún ramo ni del nervio isquiático ni del nervio pudendo. El nervio obturador no recibió ramos de los nervios espinales L4. No existían ramos a la piel desde el nervio glúteo caudal. El nervio más delgado fue el nervio pudendo. Debido a la escasez de estudios sobre el plexo lumbosacro de los gatos, este estudio completará un vacío en el campo de la anatomía veterinaria.

Application of magnetic resonance neurography in the treatment of pelvic fracture with lumbosacral plexus injury / 中华骨科杂志

Objective:To investigate the application value of magnetic resonance neurography (MRN) in pelvic fractures with lumbosacral plexus injury.Methods:From January 2014 to June 2020, data of 9 patients with pelvic fractures combined with lumbosacral plexus injury who were diagnosed with MRN and were performed surgical treatment were analyzed retrospectively. Among them, there were 8 males and 1 female, aged from 18 to 54 years, with an average age of 40.6±11.0 years. There were 2 fresh fractures within 3 weeks and 7 old pelvic fractures in 9 patients. According to AO classification, there were 6 cases of C1.3 type, 3 cases of C3 type. According to Denis classification of sacral fracture, there were 8 cases of Denis II type, 1 case of Denis III. Gibbons classification of nerve injury: 2 cases of grade II, 4 cases of grade III, 3 cases of grade IV; According to the criteria by the Nervous Injury Committee of British Medical Research Council (BMRC): 2 cases of M1, 3 cases of M2, 2 cases of M3, 2 cases of M4. Before the operation, the MRN technology was used to accurately locate the location and extent of the lumbosacral nerve injury, and nerve exploration release or internal fixation combined with nerve exploration release was employed for treatment.Results:All 9 patients underwent surgery successfully. The operation time ranged from 150 to 360 min, with an average of 217.8±63.8 min; intraoperative blood loss ranged from 200 to 1 100 ml, with an average of 388.9±293.4 ml. All patients were followed up for 21.6±19.3 months. All the fractures were healed, and the healing time was 12.7±2.2 months (range, 10-18 months). At the last follow-up, Gibbons classification of nerve injury: 3 cases of grade I, 5 cases of grade II, and 1 case of grade III. According to the criteria of BMRC: the muscle strength achieved M5 in 6 cases, M4 in 2 cases, M3 in 1 case. One patient developed a urinary system infection 2 months after discharge and recovered after treatment.Conclusion:MRN technique can assist the surgeon to fully understand the compression and traction damage of the lumbosacral nerve by the fracture before the operation, and make clear qualitative and localized diagnosis of the nerve damage, making the operation more precise and minimally invasive, which is a supplement to the traditional diagnosis method of lumbosacral plexus injury.

Use of Magnetic Resonance Neurography for Evaluating the Distribution and Patterns of Chronic Inflammatory Demyelinating Polyneuropathy

OBJECTIVE: To evaluate the distribution and characteristics of peripheral nerve abnormalities in chronic inflammatory demyelinating polyneuropathy (CIDP) using magnetic resonance neurography (MRN) and to examine the diagnostic efficiency.MATERIALS AND METHODS: Thirty-one CIDP patients and 21 controls underwent MR scans. Three-dimensional sampling perfections with application-optimized contrasts using different flip-angle evolutions and T1-/T2- weighted turbo spin-echo sequences were performed for neurography of the brachial and lumbosacral (LS) plexus and cauda equina, respectively. Clinical data and scores of the inflammatory Rasch-built overall disability scale (I-RODS) in CIDP were obtained.RESULTS: The bilateral extracranial vagus (n = 11), trigeminal (n = 12), and intercostal nerves (n = 10) were hypertrophic. Plexus hypertrophies were observed in the brachial plexus of 19 patients (61.3%) and in the LS plexus of 25 patients (80.6%). Patterns of hypertrophy included uniform hypertrophy (17 [54.8%] brachial plexuses and 21 [67.7%] LS plexuses), and multifocal fusiform hypertrophy (2 [6.5%] brachial plexuses and 4 [12.9%] LS plexuses) was present. Enlarged and/or contrast-enhanced cauda equina was found in 3 (9.7%) and 13 (41.9%) patients, respectively. Diameters of the brachial and LS nerve roots were significantly larger in CIDP than in controls (p < 0.001). The largest AUC was obtained for the L5 nerve. There were no significant differences in the course duration, I-RODS score, or diameter between patients with and without hypertrophy.CONCLUSION: MRN is useful for the assessment of distribution and characteristics of the peripheral nerves in CIDP. Compared to other regions, LS plexus neurography is more sensitive for CIDP.

The application of sacral neuromodulation in the treatment of female neurogenic lower urinary tract dysfunction / 中国医师杂志

Trauma,iatrogenic injury,and neurological disorders can lead to neurogenic lower urinary tract dysfunction (NLUTD).However,there are some special causes in women,including radical hysterectomy,mid-urethral suspension,pelvic organ prolapse repair,Fowler syndrome,interstitial cystitis etc.Traditional behavioral therapy,drug treatment and surgeries may work less well in patients with NLUTD and may even lead to progression and deterioration of the diseases.A review of current literatures revealed that there is an increasing evidence on the application of sacral neuromodulation (SNM) in the treatment of NLUTD in female.This review will provide a summary of the known mechanisms of female NLUTD and the effectiveness of SNM.

Application of sacral neuromodulation in lower urinary tract diseases related to pelvic floor dysfunction / 中国医师杂志

Pelvic floor dysfunction associated with lower urinary tract diseases,is a common disease in women.Sacral neuromodulation is a safe and effective new technique with small trauma,which has significant advantages for patients with refractory pelvic floor dysfunction-related lower urinary tract diseases and has good clinical application prospects.

Transferring fascicles of obturator nerve restoring vesical branch of pelvic nerve to treat the micturition function of patients caused by sacral plexus injury / 中华骨科杂志

Objective To explore the feasibility of transferring of the obturator nerve onto the vesical branch of pelvic nerve with direct anastomosis,in order to restore the automatic micturition function of patients with bilateral lower sacral plexus injury (S2-S4).Methods Data of five patients (4 males and 1 female) with bilateral lower sacral plexus injury who had surgery from May to July 2018 were retrospectively analyzed.The average age was 26 years old (range,23-30 years old) and the average delay from injury to operation was 10.2 months (range,7-14 months).Three patients suffered with fell off injury and two patients had car accident injury.All patients presented with continence and the urodynamics revealed flaccid neuropathic bladder with neurogenic adynamia of detrusor muscle.The vesical branch of pelvic nerve was dissected between the bladder and the ureter where it entered the bladder neck from backward to forward almost vertically.The obturator nerve was dissected along the pelvic sidewall,and the comparable bundle branch of obturator nerve was transferred onto the vesical branch of pelvic nerve with direct anastomosis.The diameter and freed length of pelvic nerve and the fascicles of the obturator nerve were measured intraoperatively,and the cutaneous sensation of medial thigh and the muscle strength of hip adduction were evaluated postoperatively.Results The surgery was performed through the traditional abdominal paramedian approach in 3 patients and through the pararectus approach in 2 patients.The vesical branch of pelvic nerve in all five patients could be revealed clearly and there was enough operative space for nerve transferring.The surgery was successful in all five patients without any complication.The donor nerves were anterior branch of obturator nerve in 2 patients,posterior branch of obturator nerve in 1 patient,2/3 fascicles of anterior branch of obturator nerve in 1 patient and 2/3 fascicles of posterior branch of obturator nerve in 1 patient.The average length and diameter of freed fascicles of obturator nerve were 2.28 cm (range,1.9-2.6 cm) and 1.36 mm (range,1.2-1.5 mm).The average length and diameter of pelvic nerve were 2.46 cm (range,2.2-2.7 cm) and 1.2 mm (range,1.1-1.3 mm).The vesical branch of pelvic nerve and the bundle branch of the obturator never were comparable and anastomosed free of tension.The sensation of medial aspect of thigh was almost normal and the muscle strength of hip adduction was M4 postoperatively.Conclusion The vesical branch of pelvic nerve can be well exposed via pararectus approach.Transferring of the fascicles of obturator nerve onto the vesical branch of pelvic nerve is feasible and safe.

Lateral rectus abdominis approach versus posteromedian sacrum approach for unstable sacral fracture complicated with lumbosacral plexus injury / 中华创伤骨科杂志

Objective To compare the lateral rectus abdominis approach versus posteromedian sacrum approach in the surgical treatment of unstable sacral fracture complicated with lumbosacral plexus injury.Methods From June 2010 to December 2014,33 unstable sacral fractures complicated with lumbosacral plexus injury were treated at Department of Orthopaedics,Spinal and Pelvic Surgery Center,Zhongnan Hospital.Of them,24 were fresh and 9 obsolete.The lateral rectus abdominis approach was adopted in 17 patients and the posteromedian sacrum approach in 16.All the patients received surgical treatment within 2 to 12 weeks (average,4.5 weeks) after injury.The 2 groups were compared in terms of operation time,bleeding volume,complications,weight-bearing time,visual analogue scale (VAS),European QOL Five Dimensional health scale (EQ-5D) and lumbosacral injury classification and severity scale (LSICS).Results The 2 groups were compatible due to their insignificant differences in baseline data (P ＞ 0.05).Their follow-up time ranged from 17 to 37 months (average,26.8 months).Perioperatively,infection and necrosis of the lumbosacral incision appeared in 2 patients and iatrogenic injury to the lumbosacral plexus in 3 patients.All the other incisions healed well without major complications like infection,pressure ulcer or implant failure.There were no significant differences between the 2 groups in operation time (235.8± 72.0 minutes versus 318.0 ± 64.7 minutes),intraoperative bleeding volume (558.8 ± 125.7 mL versus 734.0 ±98.0 mL),weight-bearing time (9.4 ±2.4 weeks versus 11.3 ±2.3 weeks),postoperative complications,VAS(1.1 ±0.6 points versus 1.0 ±0.6 points),EQ-5D (0.82 ±0.09 points versus 0.78 ±0.06 points) or LSICS (P ＞ 0.05).The final follow-ups revealed significant improvements in VAS,EQ-5D and LSICS in all the patients (P ＜ 0.05).Conclusion The lumbosacral plexus can be well decompressed via both the lateral rectus abdominis approach and the posteromedian sacrum approach,leading to satisfactory clinical outcomes.

Comparative study of lumbar plexus path on the left and right sides through the psoas muscle / Estudo comparativo do trajeto do plexo lombar nos lados direito e esquerdo através do músculo psoas / Estudio comparativo del trayecto del plexo lumbar en los lados derecho e izquierdo a través del músculo psoas

ABSTRACT Objective: Spine surgery with a minimally invasive lateral approach and validate possible anatomical differences between the right and left sides. Methods: Four measurements (cm) were taken on 38 cadavers: the distance between the lumbar plexus and the transverse process (L4-L5) and the distance between the lumbar plexus and the midline of the lumbar spine, both on the right and left sides. Results: The mean distance between the lumbar plexus and the transverse process of L4-L5 was 1.03 cm and the distance to the midline was 3.99 cm for the right side. The averages of the left side were 1.13 cm and 3.38 cm, respectively. There is statistical difference between the sides (p<0.05) using the non-parametric Wilcoxon test. Conclusions: The authors suggest that the transverse process might be used as an anatomical landmark to define the surgical approach through the psoas muscle. Level of Evidence IV; Cadaveric study.

RESUMO Objetivo: Encontrar um referencial anatômico prático e seguro durante a cirurgia com a técnica de acesso à coluna ALMI (acesso lateral minimamente invasivo) e validar possíveis diferenças anatômicas entre os lados direito e esquerdo. Método: Foram feitas 4 medidas (cm) em 38 cadáveres: entre o plexo lombar e o processo transverso de L4L5, e entre o plexo lombar e a linha média da coluna lombar dos lados direito e esquerdo. Resultados: A distância média encontrada entre o plexo lombar e o processo transverso de L4L5 foi de 1,03cm e a distância até a linha média foi de 3,99 cm do lado direito. Já do lado esquerdo, as médias são 1,13cm e 3,88cm, respectivamente. Houve diferença estatística entre os lados (p<0,05) pelo teste não-paramétrico de Wilcoxon. Conclusão: Sugere-se como referencial anatômico o processo transverso para definir o ponto de entrada do portal de trabalho no músculo psoas. Nível de Evidência IV; Estudo Cadavérico.

RESUMEN Objetivo: Encontrar una referencia anatómica práctica y segura durante la cirugía de la columna con técnica de abordaje lateral mínimamente invasivo y validar posibles diferencias anatómicas entre los lados derecho e izquierdo. Métodos: Se realizaron 4 medidas (cm) en 38 cadáveres: distancia entre el plexo lumbar y la apófisis transversa (L4-L5) y distancia entre el plexo lumbar y la línea media de la columna lumbar, en los lados derecho e izquierdo. Resultados: La distancia promedio entre el plexo lumbar y la apófisis transversa de L4-L5 fue 1,03 cm y la distancia a la línea media fue de 3,99 cm a la derecha. Los promedios de la izquierda fueron 1,13 cm y 3,88 cm respectivamente. Hay diferencia estadística entre los lados (p <0,05) mediante la prueba no paramétrica de Wilcoxon. Conclusiones: Se sugiere como referencia anatómica la apófisis transversa para definir el portal de trabajo a través del músculo psoas. Nivel de Evidencia IV; Estudio cadavérico.

Origin and distribution of femoral nerves in swine (Sus scrofa domesticus) fetuses from crosses of Dan Bred and AGPIC-337 lines / Origem e distribuição dos nervos femorais em fetos suínos (Sus scrofa domesticus - linneaus, 1758) do cruzamento das linhagens Dan Bred e AGPIC337

The objective of this work was to assess the origin and distribution of femoral nerves in 30 swine fetuses from crosses of Dan Bred and AGPIC-337 lines. Thirty animals­fifteen males and fifteen females­from the collection of the Faculty of Veterinary Medicine's Animal Anatomy Laboratory of the Federal University of Uberlândia, Uberlândia MG, Brazil, were used. The animals were fixed by injecting a 10% aqueous formaldehyde solution into the descending aorta artery and thoracic, abdominal, pelvic and intramuscular cavities. The specimens were then submerged in a solution with the same concentration. These animals have five to seven lumbar vertebrae. The number of lumbar vertebrae was six in 96.67% and seven in 3.33% of the animals. The femoral nerve originated from the L4 and L5 (66.67%), L5 and L6 (26.67%) and L3 and L4 (6.66%) lumbar vertebrae. It sent branches to the psoas major, psoas minor, iliac, pectineus, and quadriceps femoris muscles in all animals, to the sartorius in 43.33% and to the gracilis in 6.66% of animals. No marked differences were found in the characteristics of origin and distribution of the femoral nerve between the swine fetuses from crosses of Dan Bred and AGPIC-337 lines and the animals described in the literature.

Objetivou-se estudar a origem e distribuição dos nervos femorais em 30 fetos suínos oriundos do cruzamento das linhagens Dan Bred e AGPIC337. Foram utilizados 30 animais, quinze machos e quinze fêmeas, pertencente ao acervo do laboratório de Anatomia Animal da Faculdade de Medicina Veterinária da Universidade Federal de Uberlândia. A fixação dos animais se deu por meio de injeção de solução aquosa de formaldeído a 10% na artéria aorta parte descendente, cavidades torácica, abdominal, pélvica e intramusculares, em seguida, os espécimes foram submersos em solução contendo a mesma concentração. Esses animais possuem cinco a sete vértebras lombares. Em 96,67% dos animais o número de vértebras lombares foi seis e em 3,33% sete. O nervo femoral originou-se de L4 e L5 (66,67%), L5 e L6 (26,67%) e L3 e L4 (6,66%). Emitiu ramos para os músculos psoas maior, psoas menor, ilíaco, pectíneo, quadríceps femoral em 100% dos casos, 43,33% para o sartório e 6,66% para o grácil. Nota-se que não foram observadas diferenças marcantes nas características tanto na origem como na distribuição do nervo femoral entre os fetos de suínos oriundos do cruzamento das linhagens Dan Bred e AGPIC337 e os animais da literatura consultada

Efficacy of "over iliac crest method" for ultrasound-guided posterior lumbar plexus block: a comparison with manual palpation and sagittal positioning / 中华麻醉学杂志

Objective To evaluate the efficacy of "over iliac crest method" for ultrasound-guided posterior lumbar plexus block by comparing with manual palpation and sagittal positioning.Methods A total of 75 patients,aged 25-64 yr,weighing 42-90 kg,with body mass index of 17-32 kg/cm2,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,scheduled for elective lower extremity surgery under ultrasound-guided posterior lumbar plexus block combined with parasacral sciatic nerve block,were divided into 3 groups (n =25 each) using a random number table method:manual palpation group (group M),sagittal positioning group (group S) and "over iliac crest method" group (group O).Patients received ultrasound-guided posterior lumbar plexus block with in-plane technique using the corresponding positioning method in M,S and O groups.Successful blockade of each level was recorded at 30 min after injection.Time to determine the lumbar intervertebral space,puncture time for lumbar plexus block,the requirement for adjuvant drugs and block efficacy were recorded.The development of complications related to puncture and nerve block was also recorded.Results Compared with group M,the success rates of blockade at levels L1 and L2 were significantly increased,the success rates of blockade at levels L4 and L5 were decreased (P＜0.05),no significant difference was found in the success rate of blockade at level L3 (P＞0.05),the time to determine the lumbar intervertebral space was prolonged,and the requirement for adjuvant drugs was decreased during surgery in O and S groups,and the efficacy of block was significantly enhanced in group O (P＜0.05).Compared with group S,the success rates of blockade at levels L1 and L2 were significantly increased,the success rates of blockade at level L4 were decreased,the time to determine the lumbar intervertebral space was shortened (P＜0.05),and no significant change was found in the efficacy of block in group O (P＞0.05).There was no significant difference in the puncture time for lumbar plexus block between the three groups (P＞0.05).Complications related to puncture and nerve block were not found in three groups.Conclusion "Over iliac crest method" provides higher success rate and better efficacy than manual palpation and sagittal positioning when used for lumbar plexus block.

Effect of lumbar plexus-sacral plexus block combined with dexmedetomidine on rehabilitation of elderly patients undergoing PFNA / 重庆医学

Objective To evaluate the effectiveness of lumbosacral plexus block combined with the use of dexmedetomidine in elderly patients undergoing proximal femoral nail antirotation (PFNA).Methods A total of 60 patients received elective PFNA were divided into tracheal intubation combined with inhalation anesthesia group (group G) and ultrasound and nerve stimulator-guided lumbosacral plexus block following with dexmedetomidine infusion group (group N).Then we observed HR,SBP,DBP for both groups at the time entering the theater (T0),immediately after tracheal intubation or after dexmedetomidine infusion (T1),skin incision moment (T2) and 30 minutes after skin incision (T3).Visual analogue scale (VAS) scores were assessed for both groups at the time point of 2,6,12,24 and 48 hours after surgery.The number of use of patient controlled intravenous analgesia (PCIA),assessment of consciousness status 1-3 days after surgery,adverse reactions were recorded for both groups as well.The following post-surgery data were recorded:the time of first feeding,first urination and first ambulation,the length of hospitalization,the expense of hospital stay.Results HR,SBP,DBP of the group G changed more significantly at T1,T2,T3 than those of T0 (P＜0.05).The VAS scores and the number of use of PCIA of group N were lower than those of group G at all time points after operation (P＜0.05).The group N had lower CAM-CR scores and less adverse reactions of nausea and vomiting and dizziness than those of group G on days 1 to 3 after surgery (P＜0.01).Compare to group G,the group N were early in terms of post-operation first feeding,first urination and first ambulation (P＜0.01).The length of hospitalization was shorter and the cost of the hospital stay was lower in the group N than the group G (P＜0.01).Conclusion Ultrasound and nerve stimulator-guided lumbosacral plexus block combined with low dose of dexmedetomidine could meet the needs of elderly patients undergoing PFNA.

Comparison of different anesthesia techniques on early prognosis in patients undergoing hip joint re-placemen / 中华麻醉学杂志

Objective To compare the effects of different anesthesia techniques on early prognosis in patients undergoing hip joint replacement. Methods The demographic, preoperative and postoperative data of 478 patients, aged 18-95 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅳ, who underwent elective unilateral hip joint replacement in Tongji Hospital from May 2014 to December 2016, were retrospectively analyzed. Patients were divided into general anesthesia group (group GA, n=197), peripheral nerve block group ( group PNB, n=147) and peripheral nerve block combined with general an-esthesia group ( group PNB+GA, n=134) . The amount of crystalloid solution and colloid solution infused, consumption of sufentanil and requirement for vasoactive agents were recorded during operation. The dura-tion of anesthetic recovery room stay, length of hospital stay before and after operation and total length of hospital stay were recorded. The development of complications within 48 h after operation, therapy after ad-mission to intensive care unit and in-hospital fatality were also recorded. Results Compared with group GA, the intraoperative consumption of sufentanil was significantly decreased in group PNB+GA, and the a-mount of crystalloid solution infused, urine output, consumption of sufentanil, requirement for vasoactive agents and incidence of postoperative hypoxemia, pulmonary infection and acute cerebral infarction were significantly decreased in group PNB+GA ( P<0. 05) . Compared with group PNB+GA, the consumption of sufentanil, requirement for vasoactive agents and incidence of postoperative hypoxemia, pulmonary infec-tion and acute cerebral infarction were significantly decreased in group PNB (P<0. 05). Conclusion Compared with general anesthesia or with peripheral nerve block-general anesthesia, peripheral nerve block is more helpful in improving early prognosis in patients undergoing hip joint replacement.

Feasibility of using ultrasound-guided lumbosacral plexus block combined with nasopharyngeal airway in hip replacement in elderly patients with pulmonary and lumbar diseases / 中华麻醉学杂志

Objective To evaluate the feasibility of using ultrasound-guided lumbosacral plexus block combined with nasopharyngeal airway in hip replacement in elderly patients with pulmonary and lumbar diseases.Methods Eighteen elderly patients who were diagnosed as having puhnonary and lumbar diseases before operation,aged 75-97 yr,with body mass index of 18-22 kg/m2,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective unilateral total hip replacement,were enrolled in this study.Unilateral lumbosacral plexus block was performed under the guidance of ultrasound.After completion of block,mild sedation was carried out with propofol,nasopharyngeal airway was implanted,oxygen was inhaled by mask,and sedation was maintained with small doses of propofol during operation.Bispectral index value was maintained at 60-75 during operation.Mean arterial pressure and heart rate were recorded before block,at 15 min after completion of block,before implantation of nasopharyngeal airway and at 1 min after implantation of nasopharyngeal airway.The postoperative nasopharyngeal airway removal time,development of cognitive dysfunction within 7 days after operation and recurrent puhnonary complications and mortality within 30 days after operation were recorded.Results All the patients underwent operation successfully,and vital signs were stable during operation.Nasopharyngeal airway was removed within 5 min after the end of operation,recurrent pulmonary complications were not found,and no patients developed cognitive dysfunction within 7 days after operation.No patient died within 30 days after operation.Conclusion Ultrasound-guided lumbosacral plexus block combined with nasopharyngeal airway produces reliable efficacy and fewer complications when applied to hip replacement and is suitable for elderly patients with pulmonary and lumbar diseases.

Efficacy of quadriceps femoris fasciculation induced by low-current nerve stimulation when used to assist ultrasound-guided lumbar plexus block / 中华麻醉学杂志

Objective To evaluate the efficacy of quadriceps femoris fasciculation induced by lowcurrent nerve stimulation when used to assist ultrasound-guided lumbar plexus block.Methods One hundred patients of both sexes,aged 18-45 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,weighing 50-85 kg,scheduled for elective unilateral knee arthroscopy,were selected and randomly divided into 2 groups (n =50 each) using a random number table:ultrasound assisted by nerve stimulator group (group SU) and ultrasound group (group U).The shamrock method was used to perform the ultrasound-guided lumbar plexus block in two groups.In group SU,the nerve stimulator with current 0.35 mA and frequency 1 Hz was used in the process of puncture,and 0.5％ ropivacaine 0.4 ml/kg was administrated when quadriceps femoris fasciculation was induced.In group U,when the tip of the nerve stimulating needle was located around the lumbar plexus,which was confirmed by ultrasound,0.5％ ropivacaine 0.4 ml/kg was administrated.The time of puncture,depth of needle insertion,onset time of block and effective block were recorded.Motor block was assessed using the modified knee score,and the development of complications was recorded within 24 h after block.Results Compared with group U,the onset time of block was significantly shortened,the rate of effective block was increased,the degree of motor block was aggravated (P＜0.05),and no significant change was found in the time of puncture or depth of needle insertion in group SU (P＞0.05).No complications were observed in two groups.Conclusion Low-current (0.35 mA) nerve stimulation-induced quadriceps femoris fasciculation when used to assist location can improve the efficacy of ultrasound-guided lumbar plexus block.

Applied anatomy study of posterior approach via sacrectomy for reaching the deep intrapelvic sacral plexus / 中华外科杂志

Objective@#To observe the possibility of posterior approach via sacrectomy for reaching intrapelvic sacral plexus and expose the deep intrapelvic origin of sciatic nerve from sacral plexus in order to perform nerve graft.@*Methods@#Five adult cadaver specimens were used in the study with prone position in May 2012. Cut off the gluteus maximus along the origins and lift to the lateral side, the piriformis was lay beneath. The sciatic nerve and the inferior gluteal nerve pierced from the infrapiriformis foramen in the operative field. Excise the origin of the piriformis via sacrectomy with osteotome and the length and width of the insertion on sacrum were measured. The piriformis was resected and then the sacral nerve roots beneath were exposed. The S2-S4 sacral nerve roots and the deep intrapelvic origin of sciatic nerve from sacral plexus were revealed after carefully dissecting. From July 2012 to June 2016, nine patients with lumbosacral plexus injury were performed surgery through the posterior approach in Department of Hand Surgery, Beijing Jishuitan Hospital.There were 6 male and 3 female patients, with a mean age of 29 years. All patients were diagnosed as upper and lower sacral plexus injury, in one of them combing with contralateral lower sacral plexus injury. The average time from injury to operation was 8.3 months.@*Results@#The length and width of the piriformis insertion on sacrum were (3.44±0.15) cm and (2.42±0.11) cm, respectively. The deep intrapelvic origin of sciatic nerve from sacral plexus in all nine patients can be revealed clearly and there was enough operative space that nerve transfer or graft can be performed through the posterior approach via sacrectomy. The total blood loss during operation was (1 822±1 523) ml.@*Conclusion@#The piriformis and part of sacrum it attached can be resected safely through the posterior approach and the deep intrapelvic sacral plexus and the origin of sciatic nerve can be well exposed.

Comparison of continuous lumbar plexus block with different concentrations of dexmedetomidine added to ropivacaine for postoperative analgesia in elderly patients undergoing hip replacement / 中华麻醉学杂志

Objective To compare the efficacy of continuous lumbar plexus block (LPB) with different concentrations of dexmedetomidine added to ropivacaine for postoperative analgesia in elderly patients undergoing hip replacement.Methods Sixty elderly patients of both sexes,aged 65-85 yr,weighing 50-71 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective total hip replacement,were divided into 2 groups (n =30 each) using a random number table:0.5 μg/ml dexmedetomidine+0.1％ ropivacaine group (group D1) and 1.0 μg/ml dexmedetomidine + 0.1％ ropivacaine group (group D2).Lumbar-sacral plexus block combined with general anesthesia was used.At the end of operation,LPB pump was started and set up to deliver a 4 ml bolus dose with a 30 min lockout interval and background infusion at a rate of 8 ml/h.The analgesia solution contained 0.5 μg/ml dexmedetomidine and 0.1％ ropivacaine in group D1 and 1.0 μg/ml dexmedetomidine and 0.1％ ropivacaine in group D2.Postoperative analgesia lasted for 48 h,and the visual analogue scale score was maintained ≤ 3.Patientcontrolled intravenous analgesia (PCIA) pump was connected when break-through pain happened.PCIA solution contained morphine 50 mg diluted to 50 ml in 0.9％ sodium chloride.PCIA pump was set up to deliver a 1 ml bolus dose with a 5 min lockout interval and no background infusion.When the visual analogue scale score ＞3,the patient-controlled LPB pump was used first,and 15 min later if analgesia was still ineffective,PCIA pump was applied.The number of patients in whom analgesia was effective and occurrence of adverse reactions were recorded.Results Compared with group D1,the rate of effective analgesia was significantly increased,and the incidence of nausea,vomiting and pruritus was decreased in group D2 (P＜ 0.05).No bradycardia,hypotension,over-sedation,respiratory depression,urinary retention or local skin infection was found in the two groups.Conclusion Continuous LPB with 1.0 μg/ml dexmedetomidine added to 0.1％ ropivacaine provides better efficacy for postoperative analgesia in elderly patients undergoing hip replacement.

Lumbosacral plexus of the mongolian gerbil(Meriones unguiculatus Milne-Edwards, 1867) / Plexo lombossacral do gerbil (Meriones unguiculatus Milne-Edwards, 1867)

The Mongolian gerbil, belonging to the Muridae family, is characterized as an economic asset in the pet market due to its easy management. Current research analyzes and describes the origin of the nerves that make up the lumbosacral plexus in the species, foregrounding comparative anatomy, especially among wild rodents. The experiment, approved by the Committee of Institutional Bioethics, involved 15 animals which had been used in other studies and were donated to the Laboratory of Applied Animal Morphophysiology of the Federal Rural University of the Semi-Arid, Mossoró, Rio Grande do Norte, Brazil. The animals were fixed in a water solution of formaldehyde 10%. After 72 hours, they were dissected, the abdominal cavity was opened and eviscerated, and the psoas minor, psoas major and the quadratus lumborum muscles were removed to inspect the nerves that form the lumbosacral plexus. Results were given in percentages and grouped in tables. The lumbosacral plexus of the Mongolian gerbil frequently derived from the ventral roots of the last thorax nerves, from the seven lumbar nerves and from the four sacral nerves (Type II ­ T12-S4). The nerves of the gerbil´s lumbosacral plexus are the iliohypogastricus, ilioinguinalis, cutaneus femoris lateralis, genitofemoralis, femoralis, obturatorius, ischiadicus, gluteus cranialis, pudendus, gluteus caudalis and rectales caudales nerves. Information on the origin of the nerves of the gerbil´s lumbosacral plexus and their description is relevant for clinical and surgical studies, and for the application of techniques or anesthetic drugs.

O esquilo da Mongólia é um roedor pertencente à família Muridae, caracterizado por seu interesse econômico no mercado pet e por ser de fácil manejo. Esta pesquisa analisa e descreve a origem dos nervos que formam o plexo lombossacral da espécie. No experimento foram utilizados 15 animais, provenientes de outros estudos aprovados pelo Comitê de Bioética Institucional, que foram doados ao Laboratório de Morfofisiologia Animal Aplicada da Universidade Federal Rural do Semi-Árido, Mossoró, Rio Grande do Norte. Os animais foram fixados em solução aquosa de formaldeído a 10%. Após 72 horas, os animais foram dissecados, realizando-se a abertura da cavidade abdominal, depois, eviscerados e em seguida, os músculos psoas maior, psoas menor e quadrado lombar foram removidos para visualização dos nervos que formam o plexo lombossacral. Os resultados foram expressos em percentagens e agrupados em tabelas. O plexo lombossacral do gerbil originou-se mais frequentemente das raízes ventrais do último nervo torácico, dos sete nervos lombares e dos quatro nervos sacrais (Tipo II ­ T12-S4). Os nervos que formaram o plexo lombossacral do gerbil foram: ílio-hipogástrico, ílioinguinal, cutâneo femoral lateral, genitofemoral, femoral, obturatório, isquiático, glúteo cranial, pudendo, glúteo caudal, e nervo retal caudal. O conhecimento sobre a origem e os nervos do plexo lombossacral no gerbil mostra-se útil para estudos clínico-cirúrgicos e aplicação de técnicas ou fármacos anestésicos.