PDF(Pubmed)
Abstract：
Detailed understanding of the innervation of the hip capsule (HC) helps inform surgeons\' and anaesthetists\' clinical practice. Post-interventional pain following radiofrequency nerve ablation (RFA) and dislocation following total hip arthroplasty (THA) remain poorly understood, highlighting the need for more knowledge on the topic. This systematic review and meta-analysis focuses on gross anatomical studies investigating HC innervation. The main outcomes were defined as the prevalence, course, density and distribution of the nerves innervating the HC and changes according to demographic variables. HC innervation is highly variable; its primary nerve supply seems to be from the nerve to quadratus femoris and obturator nerve. Many articular branches originated from muscular branches of the lumbosacral plexus. It remains unclear whether demographic or anthropometric variables may help predict potential differences in HC innervation. Consequently, primary targets for RFA should be the anterior inferomedial aspect of the HC. For THA performed on non-risk patients, the posterior approach with capsular repair appears to be most appropriate with the lowest risk of articular nerve damage. Care should also be taken to avoid damaging vessels and muscles of the hip joint. Further investigation is required to form a coherent map of HC innervation, utilizing combined gross and histological investigation.
摘要：
详细了解髋关节囊（HC）的神经支配有助于告知外科医生和麻醉师的临床实践。射频神经消融（RFA）后的介入疼痛和全髋关节置换术（THA）后的脱位仍然知之甚少，强调需要更多关于这个主题的知识。本系统综述和荟萃分析侧重于调查HC神经支配的大体解剖学研究。主要结果定义为患病率，当然,支配HC的神经的密度和分布以及根据人口统计学变量的变化。HC神经支配是高度可变的；它的主要神经供应似乎是从神经到股方肌和闭孔神经。许多关节分支起源于腰骶丛的肌肉分支。目前尚不清楚人口统计学或人体测量变量是否有助于预测HC神经支配的潜在差异。因此,RFA的主要目标应该是HC的前下内侧。对于对无风险患者进行的THA，后路入路包膜修复似乎是最合适的，关节神经损伤的风险最低。还应注意避免损伤髋关节的血管和肌肉。需要进一步调查以形成HC神经支配的连贯图，利用结合的大体和组织学研究。
