上殿皮神経の解剖学的研究―採骨時神経損傷の予防

Anatomy Study of the Superior Cluneal Nerves. : the Prevention of Nerve Injury When Harvesting Bone from the Posterior Iliac Crest

　解剖実習用の遺体標本を用いて上殿皮神経の走行を肉眼的に観察し，後方腸骨移植骨採取における安全域を調査した．上後腸骨棘から上殿皮神経最内側枝が腸骨稜を乗り越える位置までの距離は平均4.02cm，最小値3.0cmであった．また，上殿皮神経最内側枝は靱帯組織下を走行している症例が多く，その場合，靱帯表層上を通過する神経よりも内側を通過する．しかし，両者間の差は約5mmにすぎず，両者の最小値はいずれも3.0cmであった．以上の結果から，上殿皮神経を損傷せずに採骨するための安全域は，上後腸骨棘から腸骨稜に沿う3cm以内である．

　Cadaver specimens for anatomical study were used to macroscopically examine the course of the superior cluneal nerves and the margin of safety when bone harvesting from the posterior aspect of the ilium was investigated. The average distances from the posterior superior iliac spine to the point at which the most medial branch of the superior cluneal nerves crossed the iliac crest 4.02cm, and the minimum distance was 3.0cm. The most medial branch of the superior cluneal nerves often passed under the lumbar back aponeurosis, and thus more medially than the nerves that pass over the lumbar back aponeurosis surface.

　However, the difference in distance between the most medial branch of the superior cluneal nerves that passed under the lumbar back aponeurosis and that passed over the lumbar back aponeurosis surface was merely approximately 5mm, and the minimum of both was 3.0cm. Based on the above findings, there is less than 3cm margin of safety from the posterior superior iliac spine along the iliac crest for harvesting bone without injuring the superior cluneal nerve.