Öz
Amaç: Çalışmanın amacı musculus
piriformis, siyatik sinir ve dallarının varyasyonlarını göstermek ve klinik
önemini tartışmaktır.
Gereç ve Yöntem: Ege Üniversitesi Tıp Fakültesi, Anatomi Anabilim Dalı’nda formalin ile
fikse edilmiş 26 erkek kadavraya ait 52 adet gluteal bölge ve alt ekstremite
değerlendirildi. Siyatik sinir ve musculus piriformis arasındaki anatomik
ilişki ile uylukta siyatik sinirin dallanma seviyesi kaydedildi.
Bulgular: Alt ekstremitelerin %84.62’sinde siyatik sinir pelvisten tek dal
halinde, varyasyonsuz olarak çıktı. Siyatik sinirin dallanma varyasyonu %23.08
olarak tespit edildi. On iki adet olarak bulunan yüksekten ayrılmanın 8’i
gluteal bölgede idi (%15.38). Dört alt ekstremitede (%7.69) nervus peroneus
communis ve nervus tibialis derin gluteal bölgeye foramen ischiadicum majus
yolu ile musculus piriformis’in altından ayrı ayrı girdi. Dört alt ekstremitede
ise (%7.69) iki ayrı dal musculus piriformis’in üzerinden, içinden (ya da
altından) geçti ve nervus tibialis musculus piriformis’in altından geçerken bu
iki dal da nervus peroneus communis’i oluşturmak üzere daha sonra birleşti. On
iki örneğin ikisinde, yüksekte ayrılma unilateral olarak uyluğun 1/3 üst
bölümünde izlendi. Siyatik sinirin fossa poplitea’da dallarına ayrılması da iki
alt ekstremitede görüldü (%3.85).
Sonuç: Siyatik sinirin musculus piriformis çevresindeki veya uyluktaki varyasyonları;
piriformis sendromu, total kalça protezi sonrası ortaya çıkan paralizi, gluteal
bölgeye uygulanan intramusküler enjeksiyonlar ve başarısız popliteal sinir
bloğu yönü ile tartışıldı.
Anahtar Kelimeler
Siyatik sinir piriformis sendromu paralizi kalça replasmanı anatomik varyasyonlar.
Kaynakça
- Natsis K, Totlis T, Konstantinidis GA, Paraskevas G, Piagkou M, Koebke J. Anatomical variations between the sciatic nerve and the piriformis muscle a contribution to surgical anatomy in piriformis syndrome. Surg Radiol Anat 2014;36(3):273-80.
- Cassidy L, Walters A, Bubb K, Shoja MM, Tubbs RS, Loukas M. Piriformis syndrome: Implications of anatomical variations, diagnostic techniques, and treatment options. Surg Radiol Anat 2012;34(6):479-86.
- Kanawati AJ. Variations of the sciatic nerve anatomy and blood supply in the gluteal region: A review of the literature. ANZ J Surg 2014;84(11):816-9.
- Pokorny D, Jahoda D, Veigl D, Pinskerová V, Sosna A. Topographic variations of the relationship of the sciatic nerve and the piriformis muscle and its relevance to palsy after total hip arthroplasty. Surg Radiol Anat 2006;28(1):88-91.
- Smoll NR. Variations of the piriformis and sciatic nerve with clinical consequence: A review. Clin Anat 2010;23(1):8-17.
- Adibatti M, V S. Study on variant anatomy of sciatic nerve. J Clin Diagn Res 2014;8(8):AC07-9.
- Grgić V. Piriformis muscle syndrome: Etiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis and therapy. Lijec Vjesn 2013;135(1-2):33-40.
- Güvençer M, Iyem C, Akyer P, Tetik S, Naderi S. Variations in the high division of the sciatic nerve and relationship between the sciatic nerve and the piriformis. Turk Neurosurg 2009;19(2):139-44.
- Prakash, Bhardwaj AK, Devi MN, Sridevi NS, Rao PK, Singh G. Sciatic nerve division: A cadaver study in the Indian population and review of the literature. Singapore Med J 2010;51(9):721-3.
- Coelho P, Melo C, Bernardes A. Rare anatomical variation of absence of the sciatic nerve: Completely substituted by the tibial and common fibular nerve. Acta Med Port 2013;26(3):283-6.
- Battaglia PJ, Scali F, Enix DE. Co-presentation of unilateral femoral and bilateral sciatic nerve variants in one cadaver: A case report with clinical implications. Chiropr Man Therap 2012;20(1):34.
- Hopayian K, Song F, Riera R, Sambandan S. The clinical features of the piriformis syndrome: A systematic review. Eur Spine J 2010;19(12):2095-109.
- Delabie A, Peltier J, Havet E, Page C, Foulon P, Le Gars D. Relationships between piriformis muscle and sciatic nerve: radioanatomical study with 104 buttocks. Morphologie 2013;97(316):12-8.
- Gomes BA, Ramos MR, Fiorelli RK, Almeida CR, Fiorelli SK. Topographic anatomical study of the sciatic nerve relationship to the posterior portal in hip arthroscopy. Rev Col Bras Cir 2014;41(6):440-4.
- Vloka JD, Hadzić A, April E, Thys DM. The division of the sciatic nerve in the popliteal fossa: Anatomical implications for popliteal nerve blockade. Anesth Analg 2001;92(1):215-7.
- Saleh HA, El-fark MM, Abdel-Hamid GA. Anatomical variation of sciatic nerve division in the popliteal fossa and its implication in popliteal nerve blockade. Folia Morphol (Warsz) 2009;68(4):256-9.
- Chiang EP, Dangerfield P, Asay D, Cucchiaro A, Berger JS. Ultrasound imaging of the sciatic nerve division in the popliteal fossa: a volunteer study. Open J Anesthesiol 2013;3(5):288-292.
- Beaton LE, Anson BJ. The relation of the sciatic nerve and of its subdivisions to the piriformis muscle. Anat Rec 1937;70(1):1-5.
- Beaton LE, Anson BJ. The sciatic nerve and the piriformis muscle: Their interrelation a possible cause of coccygodynia. J Bone Joint Surg 1938;20(3):686-8.
- Pais D, Casal D, Bettencourt Pires MA, Furtado A, et al. Sciatic nerve high division: two different anatomical variants. Acta Med Port 2013;26(3):208-11.
- Broadhurst NA, Simmons DN, Bond MJ. Piriformis syndrome: Correlation of muscle morphology with symptoms and signs. Arch Phys Med Rehabil 2004;85(12):2036-39.
- Kirschner JS, Foye PM, Cole JL. Piriformis syndrome, diagnosis and treatment. Muscle Nerve 2009;40(1):10-18.
- Moore KL, Dalley AF. Clinically Oriented Anatomy. Fourth Edition. London: Lippincott, Williams & Wilkins; 1999:560.
- Khan RJ, Fick D, Khoo P, Yao F, Nivbrant B, Wood D. Less invasive total hip arthroplasty: Description of a new technique. J Arthroplasty 2006;21(7):1038-46.
- Sosna A, Pokorny D, Jahoda D. Sciatic nerve palsy after total hip replacement. J Bone Joint Surg 2005;87(8):1140-1.
Öz
Aim: The
aim of present study was to demonstrate the variations of piriformis muscle,
sciatic nerve and its branches and discuss their clinical importance.
Materials and Methods: Fifty-two gluteal and lower limb regions of 26 formalin fixed male
cadavers were evaluated in Ege University Faculty of Medicine, Department of Anatomy.
The anatomical relationship between the sciatic nerve and the piriformis
muscle, and division level of sciatic nerve in thigh was recorded.
Results: The
sciatic nerve exited the pelvis as a single branch through the infrapiriform
foramen with no variation in 84.62% of the lower limbs. The division variations
of sciatic nerve were determined in 23.08%. In 8 of 12 high divisions were
observed in gluteal regions (15.38%). The common peroneal nerve and the tibial
nerve entered deep gluteal region via the greater sciatic foramen below
piriformis muscle separately in four lower limbs (7.69%). Two separate nerve
divisions passed above and through (or below) the piriformis muscle and then
combined together to form common peroneal nerve while tibial nerve passing
below the piriformis muscle in 4 lower limbs (7.69%). In 2 of 12, high division
occurred in the 1/3 upper portion of the thigh unilaterally (3.85%). The division
of sciatic nerve in the popliteal fossa was seen in two lower limbs (3.85%).
Conclusion: The clinical importance of the sciatic nerve around the piriformis
muscle or in the thigh was discussed for piriformis syndrome, palsy after total
hip arthroplasty, intramuscular injections in gluteal region and failed
popliteal nerve block.
Anahtar Kelimeler
Sciatic nerve piriformis syndrome palsy hip replacement anatomical variations.
Kaynakça
- Natsis K, Totlis T, Konstantinidis GA, Paraskevas G, Piagkou M, Koebke J. Anatomical variations between the sciatic nerve and the piriformis muscle a contribution to surgical anatomy in piriformis syndrome. Surg Radiol Anat 2014;36(3):273-80.
- Cassidy L, Walters A, Bubb K, Shoja MM, Tubbs RS, Loukas M. Piriformis syndrome: Implications of anatomical variations, diagnostic techniques, and treatment options. Surg Radiol Anat 2012;34(6):479-86.
- Kanawati AJ. Variations of the sciatic nerve anatomy and blood supply in the gluteal region: A review of the literature. ANZ J Surg 2014;84(11):816-9.
- Pokorny D, Jahoda D, Veigl D, Pinskerová V, Sosna A. Topographic variations of the relationship of the sciatic nerve and the piriformis muscle and its relevance to palsy after total hip arthroplasty. Surg Radiol Anat 2006;28(1):88-91.
- Smoll NR. Variations of the piriformis and sciatic nerve with clinical consequence: A review. Clin Anat 2010;23(1):8-17.
- Adibatti M, V S. Study on variant anatomy of sciatic nerve. J Clin Diagn Res 2014;8(8):AC07-9.
- Grgić V. Piriformis muscle syndrome: Etiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis and therapy. Lijec Vjesn 2013;135(1-2):33-40.
- Güvençer M, Iyem C, Akyer P, Tetik S, Naderi S. Variations in the high division of the sciatic nerve and relationship between the sciatic nerve and the piriformis. Turk Neurosurg 2009;19(2):139-44.
- Prakash, Bhardwaj AK, Devi MN, Sridevi NS, Rao PK, Singh G. Sciatic nerve division: A cadaver study in the Indian population and review of the literature. Singapore Med J 2010;51(9):721-3.
- Coelho P, Melo C, Bernardes A. Rare anatomical variation of absence of the sciatic nerve: Completely substituted by the tibial and common fibular nerve. Acta Med Port 2013;26(3):283-6.
- Battaglia PJ, Scali F, Enix DE. Co-presentation of unilateral femoral and bilateral sciatic nerve variants in one cadaver: A case report with clinical implications. Chiropr Man Therap 2012;20(1):34.
- Hopayian K, Song F, Riera R, Sambandan S. The clinical features of the piriformis syndrome: A systematic review. Eur Spine J 2010;19(12):2095-109.
- Delabie A, Peltier J, Havet E, Page C, Foulon P, Le Gars D. Relationships between piriformis muscle and sciatic nerve: radioanatomical study with 104 buttocks. Morphologie 2013;97(316):12-8.
- Gomes BA, Ramos MR, Fiorelli RK, Almeida CR, Fiorelli SK. Topographic anatomical study of the sciatic nerve relationship to the posterior portal in hip arthroscopy. Rev Col Bras Cir 2014;41(6):440-4.
- Vloka JD, Hadzić A, April E, Thys DM. The division of the sciatic nerve in the popliteal fossa: Anatomical implications for popliteal nerve blockade. Anesth Analg 2001;92(1):215-7.
- Saleh HA, El-fark MM, Abdel-Hamid GA. Anatomical variation of sciatic nerve division in the popliteal fossa and its implication in popliteal nerve blockade. Folia Morphol (Warsz) 2009;68(4):256-9.
- Chiang EP, Dangerfield P, Asay D, Cucchiaro A, Berger JS. Ultrasound imaging of the sciatic nerve division in the popliteal fossa: a volunteer study. Open J Anesthesiol 2013;3(5):288-292.
- Beaton LE, Anson BJ. The relation of the sciatic nerve and of its subdivisions to the piriformis muscle. Anat Rec 1937;70(1):1-5.
- Beaton LE, Anson BJ. The sciatic nerve and the piriformis muscle: Their interrelation a possible cause of coccygodynia. J Bone Joint Surg 1938;20(3):686-8.
- Pais D, Casal D, Bettencourt Pires MA, Furtado A, et al. Sciatic nerve high division: two different anatomical variants. Acta Med Port 2013;26(3):208-11.
- Broadhurst NA, Simmons DN, Bond MJ. Piriformis syndrome: Correlation of muscle morphology with symptoms and signs. Arch Phys Med Rehabil 2004;85(12):2036-39.
- Kirschner JS, Foye PM, Cole JL. Piriformis syndrome, diagnosis and treatment. Muscle Nerve 2009;40(1):10-18.
- Moore KL, Dalley AF. Clinically Oriented Anatomy. Fourth Edition. London: Lippincott, Williams & Wilkins; 1999:560.
- Khan RJ, Fick D, Khoo P, Yao F, Nivbrant B, Wood D. Less invasive total hip arthroplasty: Description of a new technique. J Arthroplasty 2006;21(7):1038-46.
- Sosna A, Pokorny D, Jahoda D. Sciatic nerve palsy after total hip replacement. J Bone Joint Surg 2005;87(8):1140-1.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Haziran 2018 |
| Gönderilme Tarihi | 15 Şubat 2017 |
| Yayımlandığı Sayı | Yıl 2018 |