• Journal of Korean Neurosurgical Society
• /
• 제59권3호
• /
• pp.282-286
• /
• 2016

Objective : Obturator neuropathy is a rare condition. Many neurosurgeons are unfamiliar with the obturator nerve anatomy. The purpose of this study was to define obturator nerve landmarks around the obturator foramen. Methods : Fourteen cadavers were studied bilaterally to measure the distances from the nerve root to relevant anatomical landmarks near the obturator nerve, including the anterior superior iliac spine (ASIS), the pubic tubercle, the inguinal ligament, the femoral artery, and the adductor longus. Results : The obturator nerve exits the obturator foramen and travels infero-medially between the adductors longus and brevis. The median distances from the obturator nerve exit zone (ONEZ) to the ASIS and pubic tubercle were 114 mm and 30 mm, respectively. The median horizontal and vertical distances between the pubic tubercle and the ONEZ were 17 mm and 27 mm, respectively. The shortest median distance from the ONEZ to the inguinal ligament was 19 mm. The median inguinal ligament lengths from the ASIS and the median pubic tubercle to the shortest point were 103 mm and 24 mm, respectively. The median obturator nerve lengths between the ONEZ and the adductor longus and femoral artery were 41 mm and 28 mm, respectively. Conclusion : The obturator nerve exits the foramen 17 mm and 27 mm on the horizontal and sagittal planes, respectively, from the pubic tubercle below the pectineus muscle. The shallowest area is approximately one-fifth medially from the inguinal ligament. This study will help improve the accuracy of obturator nerve surgeries to better establish therapeutic plans and decrease complications.

• The Korean Journal of Pain
• /
• 제22권1호
• /
• pp.78-82
• /
• 2009

Obturator nerve block has been used for analgesia of hip pain, relaxation of adductor muscle spasm related to cerebral palsy or paraplegia and in urologic surgery to prevent inadvertent obturator activity during lateral wall cystoscopy. Recently, ultrasound guidance has gained popularity in the field of peripheral nerve block and have been reported in some benefits. We describe here successfully performed both obturator nerve block under ultrasound guidance.

• The Korean Journal of Pain
• /
• 제24권3호
• /
• pp.164-168
• /
• 2011

Obturator nerve block has been commonly used for pain management to prevent involuntary reflex of the adductor thigh muscles. One of several options for this block is chemical neurolysis. Neurolysis is done with chemical agents. Chemical agents used in the neurolysis of the obturator nerve have been alcohol, phenol, and botulinum toxin. In the current case, a patient with spasticity of the adductor thigh muscle due to cervical cord injury had obturator nerve neurolysis done with botulinum toxin type B (BoNT-B). Most of the previous studies have used BoNT-A with only a few reports that have used BoNT-B. BoNT-B has several advantages and disadvantages over BoNT-A. Thus, we report herein a patient who successfully received obturator nerve neurolysis using BoNT-B to treat adductor thigh muscle spasm.

• The Korean Journal of Pain
• /
• 제19권2호
• /
• pp.282-284
• /
• 2006

Percutaneous radiofrequency thermocoagulation has been applied in patients with various forms of chronic pain, such as facet joint pain, cancer pain and trigeminal neuralgia. A major portion of the hip joint is innervated by the articular branches of the femoral and obturator nerves. Radiofrequency thermocoagulation of the articular branches of the obturator and femoral nerves can be a good alternative treatment for patients with hip joint pain, especially in those where surgery is not applicable. A patient suffering hip joint pain due to metastatic cancer underwent multiple radiofrequency lesioning of the femoral and obturator nerves at $80^{\circ}C$ for 120 seconds, using a Racz-Finch Kit. The patient experienced about a 50% reduction in the pain, without any numbness or other side effects.

• Archives of Plastic Surgery
• /
• 제49권6호
• /
• pp.769-772
• /
• 2022

Femoral nerve injuries are devastating injuries that lead to paralysis of the quadriceps muscles, weakening knee extension to prohibit ambulation. We report a devastating case of electrical injury-induced femoral neuropathy, where no apparent site of nerve disruption can be identified, thus inhibiting the traditional choices of nerve reconstruction such as nerve repair, grafting, or transfer. Concomitant spinal cord injury resulted in spastic myopathy of the antagonist muscles that further restricted knee extension. Our strategy was to perform (1) supercharge end-to-side technique (SETS) to augment the function of target muscles and (2) fractional tendon lengthening to release the spastic muscles. Dramatic postoperative improvement in passive and active range of motion highlights the effectiveness of this strategy to manage partial femoral nerve injuries.

• 한방재활의학과학회지
• /
• 제30권3호
• /
• pp.163-169
• /
• 2020

This study reports on the effectiveness of Korean traditional medicine treatment on a patient with right hip pain caused by obturator nerve entrapment due to ganglion cyst. The patient had been misdiagnosed for a stenosis at the other hospital, but he got a different diagnosis this time with the examination. The patient was treated with Korean traditonal medicine, which includes pharmacopuncture, acupuncture, manual treatment (Chuna), and herbal medicine. Numerical rating scale (NRS), Oswestry Disability Index (ODI) and Euroqol five dimension (EQ-5D) index were used as a objective tool for evaluating the patient's symptoms. After treatment, NRS and ODI were decreased, while EQ-5D index was increased. This study suggests that a combined Korean traditional medicine may be effective in reducing symptoms related to obturator nerve entrapment.

• Archives of Plastic Surgery
• /
• 제50권6호
• /
• pp.578-585
• /
• 2023

An artificial sphincter implanted in the bulbous urethra to treat severe postprostatectomy urinary incontinence is effective, but embedding-associated complications can occur. We assessed the feasibility, efficacy, and safety of urethral graciloplasty cross-innervated by the pudendal nerve. A simulation surgery on three male fresh cadavers was performed. Both ends of the gracilis muscle were isolated only on its vascular pedicle with proximal end of the obturator nerve severed and transferred to the perineum. We examined whether the gracilis muscle could be wrapped around the bulbous urethra and whether the obturator nerve was long enough to suture with the pudendal nerve. In addition, surgery was performed on a 71-year-old male patient with severe urinary incontinence. The postoperative 12-month outcomes were assessed using a 24-hour pad test and urodynamic study. In all cadaveric simulations, the gracilis muscles could be wrapped around the bulbous urethra in a γ-loop configuration. The length of the obturator nerve was sufficient for neurorrhaphy with the pudendal nerve. In the clinical case, the postoperative course was uneventful. The mean maximum urethral closure pressure and functional profile length increased from 40.7 to 70 cm H₂O and from 40.1 to 45.3 mm, respectively. Although urinary incontinence was not completely cured, the patient was able to maintain urinary continence at night. Urethral graciloplasty cross-innervated by the pudendal nerve is effective in raising the urethral pressure and reducing urinary incontinence.

• Journal of Korean Neurosurgical Society
• /
• 제41권1호
• /
• pp.22-26
• /
• 2007

Objective : Cerebral palsy may induce harmful spastic hip adduction. We report the result of microsurgical selective obturator neurotomy, performed on 12 spastic hip adductions of 6 patients, followed clinically for at least 26 months postoperatively. Methods : Microsurgical selective obturator neurotomies, involving microsurgical resection of the anterior obturator nerve branches were performed on 6 patients from January 2000 through June 2003. All patients presented with the inability to sit and 2 patients complained of persistent, intractable pain. We used intraoperative bipolar stimulation to identify selected motor branches. Results : The procedure was performed bilaterally in all patients. In the 3 patients in whom contractures were present, microsurgical selective obturator neurotomies were accompanied by an additional tenotomy of the adductor muscles. Selective tibial neurotomy was performed on three of six patients who originally presented with a spastic ankle. Postoperatively, all spastic hip adductions were corrected more than 60 degrees in passive abduction-adduction amplitude. However, one patient who did not receive active postoperative physiotherapy demonstrated a decreased passive abduction-adduction amplitude upon follow-up. There were no surgical complications. Conclusion : We think microsurgical selective obturator neurotomy may be an effective procedure in the treatment of localized, harmful spastic hip adduction after failure of well conducted conservative treatment. As muscular contractions are often associated with spasticity of the hip adductors, an adjunctive tenotomy may be an option. Comprehensive postoperative physiotherapy is essential to improve long-term results.

• 대한한의학회지
• /
• 제32권3호
• /
• pp.1-9
• /
• 2011

Objectives: This study was carried out to observe the foot gworeum meridian muscle from a viewpoint of human anatomy on the assumption that the meridian muscle system is basically matched to the meridian vessel system as a part of the meridian system, and further to support the accurate application of acupuncture in clinical practice. Methods: Meridian points corresponding to the foot gworeum meridian muscle at the body surface were labeled with latex, being based on Korean standard acupuncture point locations. In order to expose components related to the foot gworeum meridian muscle, the cadaver was then dissected, being respectively divided into superficial, middle, and deep layers while entering more deeply. Results: Anatomical components related to the foot gworeum meridian muscle in human are composed of muscles, fascia, ligament, nerves, etc. The anatomical components of the foot gworeum meridian muscle in cadaver are as follows: 1. Muscle: Dorsal pedis fascia, crural fascia, flexor digitorum (digit.) longus muscle (m.), soleus m., sartorius m., adductor longus m., and external abdominal oblique m. aponeurosis at the superficial layer, dorsal interosseous m. tendon (tend.), extensor (ext.) hallucis brevis m. tend., ext. hallucis longus m. tend., tibialis anterior m. tend., flexor digit. longus m., and internal abdominal oblique m. at the middle layer, and finally posterior tibialis m., gracilis m. tend., semitendinosus m. tend., semimembranosus m. tend., gastrocnemius m., adductor magnus m. tend., vastus medialis m., adductor brevis m., and intercostal m. at the deep layer. 2. Nerve: Dorsal digital branch (br.) of the deep peroneal nerve (n.), dorsal br. of the proper plantar digital n., medial br. of the deep peroneal n., saphenous n., infrapatellar br. of the saphenous n., cutaneous (cut.) br. of the obturator n., femoral br. of the genitofemoral n., anterior (ant.) cut. br. of the femoral n., ant. cut. br. of the iliohypogastric n., lateral cut. br. of the intercostal n. (T11), and lateral cut. br. of the intercostal n. (T6) at the superficial layer, saphenous n., ant. division of the obturator n., post. division of the obturator n., obturator n., ant. cut. br. of the intercostal n. (T11), and ant. cut. br. of the intercostal n. (T6) at the middle layer, and finally tibialis n. and articular br. of tibial n. at the deep layer. Conclusion: The meridian muscle system seemed to be closely matched to the meridian vessel system as a part of the meridian system. This study shows comparative differences from established studies on anatomical components related to the foot gworeum meridian muscle, and also from the methodical aspect of the analytic process. In addition, the human foot gworeum meridian muscle is composed of the proper muscles, and also may include the relevant nerves, but it is as questionable as ever, and we can guess that there are somewhat conceptual differences between terms (that is, nerves which control muscles in the foot gworeum meridian muscle and those which pass nearby) in human anatomy.

• 한국임상수의학회지
• /
• 제26권6호
• /
• pp.632-636
• /
• 2009

회음부 팽대 병력을 보이는 세 마리 개가 건국대학교 부속 동물병원과 한강 동물병원에 내원하였다. 회음부 팽대 외에 다른 증상이 없었으며 신체 검사에서 두 마리는 환납성 한 마리는 비 환납성임을 확인 하였다. 일반 방사선 사진에서 골반강 또는 복강 내 장기가 탈장 낭 내에 없음을 확인하였다. 회음 탈장의 교정을 위해 내폐쇄근 변위 탈장 봉합술 실시 하였다. 한 마리에서 수술 후 지방을 함유하고 있는 대측 탈장이 확인되었다. 수술 후 정기 점진은 수의사의 신체 검사 혹은 보호자와의 전화 통화를 통해 실시 되었으며 세 마리 모두에서 수술과 관련한 좌골 신경 손상, 직장 탈출, 수술 부위 열개, 회음 탈장 재발과 같은 합병 증상이 없음을 확인하였다.