A New Technique of Percutaneous Minimally Invasive Surgery Assisted by Magnetic Resonance Neurography

Overview

Journal Bone Jt Open

Date 2024 Sep 18

PMID 39293800

Authors

Jiakai Gao

Na Chai

Taoran Wang

Zhiwei Han

Jingdi Chen

Gang Lin

Yaoping Wu

Long Bi

Affiliations

Soon will be listed here.

Abstract

Aims: In order to release the contracture band completely without damaging normal tissues (such as the sciatic nerve) in the surgical treatment of gluteal muscle contracture (GMC), we tried to display the relationship between normal tissue and contracture bands by magnetic resonance neurography (MRN) images, and to predesign a minimally invasive surgery based on the MRN images in advance.

Methods: A total of 30 patients (60 hips) were included in this study. MRN scans of the pelvis were performed before surgery. The contracture band shape and external rotation angle (ERA) of the proximal femur were also analyzed. Then, the minimally invasive GMC releasing surgery was performed based on the images and measurements, and during the operation, incision lengths, surgery duration, intraoperative bleeding, and complications were recorded; the time of the first postoperative off-bed activity was also recorded. Furthermore, the patients' clinical functions were evaluated by means of Hip Outcome Score (HOS) and Ye et al's objective assessments, respectively.

Results: The contracture bands exhibited three typical types of shape - feather-like, striped, and mixed shapes - in MR images. Guided by MRN images, we designed minimally invasive approaches directed to each hip. These approaches resulted in a shortened incision length in each hip (0.3 cm (SD 0.1)), shorter surgery duration (25.3 minutes (SD 5.8)), less intraoperative bleeding (8.0 ml (SD 3.6)), and shorter time between the end of the operation and the patient's first off-bed activity (17.2 hours (SD 2.0)) in each patient. Meanwhile, no serious postoperative complications occurred in all patients. The mean HOS-Sports subscale of patients increased from 71.0 (SD 5.3) to 94.83 (SD 4.24) at six months postoperatively (p < 0.001). The follow-up outcomes from all patients were "good" and "excellent", based on objective assessments.

Conclusion: Preoperative MRN analysis can be used to facilitate the determination of the relationship between contracture band and normal tissues. The minimally invasive surgical design via MRN can avoid nerve damage and improve the release effect.

Citing Articles

Minimally invasive treatment of grade I and II gluteal muscle contracture using a self-made special cutter combined with a specialized compression hemostasis device.

Yang Y, Peng Z, Shi L, Wang Y, Wang Y, Ge B BMC Musculoskelet Disord. 2024; 25(1):1024.

PMID: 39702133 PMC: 11660755. DOI: 10.1186/s12891-024-08150-1.

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