Anatomical and topographic substantiation of surgical treatment of obturator nerve neuralgia on cadaveric material

SUMMARY. Currently, there are conflicting data on the results of surgical treatment of patients with obturator neuralgia in chronic pain in the hip joint. The scarce information available in the specialized literature indicates frequent variability of the obturator nerve and its branches.

PURPOSE OF THE STUDY: to study the topographic features of the obturator nerve and its branches in a cadaveric study for the anatomical justification of surgical treatment for its neuralgia.

MATERIALS AND METHODS: 30 lower limbs (15 right and 15 left) from 15 cadavers (10 men, 5 women) were studied. The age of the deceased varied from 45 to 70 years. Racial and ethnic affiliation included 8 cadavers of the Caucasoid race, 7 of the Mongoloid race. The obturator nerve and its branches were isolated by layer-by-layer preparation from the obturator canal to the lower third of the femur along the Ken line.

RESULTS: localization of the bifurcation of the obturator nerve in 80 % of cases occurred inside the obturator canal, in 13.3 % — after exiting the canal, and in 6.7 % — inside the pelvic cavity. The innervation of the capsule of the hip joint was carried out by the articular branch, which in most cases departed from the common trunk of the obturator nerve inside the canal of the same name in 77.3 %, from its anterior branch in 16.7 %, from its posterior branch in 10 %.

CONCLUSION: detailed knowledge of anatomy and reliable information about the variant structure of the obturator nerve and its branches will improve the results of surgical treatment of patients with chronic pain in the hip joint due to obturator nerve neuralgia. Taking into account the found anatomical and topographic features, an additional point of destruction of the articular branch of the obturator nerve is needed, which will cover a wide range of impact on, regardless of its origin.

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