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The sciatic nerve division in the gluteal region in a South African population: An anatomical study

dc.contributor.advisorGreyling, L. M.en_ZA
dc.contributor.authorBergsteedt, Bryan Jasonen_ZA
dc.contributor.otherStellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Biomedical Sciences: Anatomy and Histology.en_ZA
dc.date.accessioned2019-02-14T09:04:11Z
dc.date.accessioned2019-04-17T08:18:24Z
dc.date.available2019-02-14T09:04:11Z
dc.date.available2019-04-17T08:18:24Z
dc.date.issued2019-04
dc.identifier.urihttp://hdl.handle.net/10019.1/105909
dc.descriptionThesis (MSc)--Stellenbosch University, 2019.en_ZA
dc.description.abstractENGLISH ABSTRACT: The sciatic nerve is repeatedly involved in the daily medical practices of anaesthesia, neurology, orthopaedics and rehabilitative medicine. The sciatic nerve, and its branches, are some of the most frequently injured nerves within the human body. A possible reason for injury could be related to an inadequate knowledge of the anatomical variations of this nerve. Adequate understanding of the anatomical variability within the gluteal region is vital for appropriate diagnosis, potential treatment of gluteal pathology and pain and population-specific anomalies. To the author’s best knowledge, no previous study has described the anatomical variations in relation to the piriformis and sciatic nerve bifurcation within the South African population. Therefore, the aim of the study is to report the prevalence of anatomical variations within the course of the sciatic nerve in relation to the piriformis muscle. Additionally, to report the prevalence of the variations in the level of the sciatic nerve bifurcation. Lastly, to analyse the typical sciatic nerve and piriformis morphomety. The results obtained will be a comparison between sides, sexes, and population groups. For the purpose of this study, lower limbs (𝑁=340) from 170 South African cadavers were selected for dissection and morphological analysis. These specimens consisted of 191 males and 149 females, and comprised of three South African subpopulation groups, namely, White/Caucasian (𝑛=232), Mixed race (𝑛=78) and South African Black (𝑛=30). The variations were recorded, classified and described. Piriformis and sciatic nerve parameters were measured morphometrically using a digital sliding calliper, and statistically analysed. Analysis of the relationship between piriformis and the sciatic nerve resulted in 43 (12.65%) specimens that presented variations in the morphology, while 297 (87.35%) specimens presented normal anatomical features. Variations of these structures occurred predominantly in the South African White/Caucasian population. The bifurcation of the sciatic nerve occurred mainly in the popliteal fossa proper (79.6%). The width of the sciatic nerve was significantly larger in the White/Caucasian group (𝑝<0.05), in comparison to the other two groups. The mean length of the sciatic nerve was significantly larger in the male specimens (𝑝<0.05) in comparison to the female specimens. It was found that the sciatic nerve commonly entered the gluteal region as a single trunk, through the infra-piriform space, inferior to the piriformis muscle. However, variations in the anatomy of the sciatic nerve are common, and are vital in assessing clinical risk, and avoiding debilitating injury or incorrect pain diagnoses. To maintain best possible clinical practices requires regularly updated clinical skills in relation to accurate and relevant new anatomical knowledge. It is for this reason that studies, such as this one, ensure that vital research contributions are available for best clinical practice. Clear uniform landmarks for morphometric analysis of the sciatic nerve and piriformis needs to be established in order to create uniformity and understanding of results. Additionally, there is a need for the increase in published literature for the South African subpopulation groups in order to strengthen comparisons and conclusions of reported research. Researchers also need to research variations in larger groups within the South African population.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING: N. ischiadicus is dikwels betrokke in mediese praktyke soos narkose, neurologie, ortopedie en rehabilitasie geneeskunde. N. ischiadicus, sy vertakkings, is ook die senuwee in die menslike liggaam wat die meeste beseer word. Onvoldoende kennis oor anatomiese variasies van die senuwee is ’n moontlike rede tot beserings. Dit is van kardinale belang om voldoende kennis van die anatomiese variasies in die gluteale gebied op te doen, vir korrekte diagnose en potensiële behandeling van gluteale patologie en -pyn, asook van bevolkingspesifieke anomalieë. Geen vorige studies wat die verskille in die verhouding tussen m. piriformis en bifurkasie van n. isciadicus beskryf, bestaan, sover die navorser kon bepaal, vir die bevolkingsgroepe in Suid-Afrika nie. Die doel van hierdie studie was dus om verslag te doen oor die voorkoms van anatomiese variasies in die verloop van n. ischiadicus in verhouding tot m. piriformis. Die voorkoms van variasies op die vlak van bifurkasie van n. ischiadicus is ook bestudeer. Laastens is ‘n tipiese n.ischiadicus en m. piriformis morfometries geanaliseer. Die resultate is tussen linker en regter kante van die liggaam, geslagte en bevolkingsgroepe vergelyk. Vir die doel van hierdie studie is onderste ledemate (𝑁 = 340) van 170 Suid-Afrikaanse kadawers vir disseksie en morfologiese analise, geselekteer. Die liggame wat bestudeer is, het bestaan uit 191 mans en 149 vroue, en is oor drie Suid-Afrikaanse bevolkingsgroepe versprei, naamlik Wit (𝑛 = 232), Kleurling (𝑛 = 78) en Swart (𝑛 = 30). Verskille is bestudeer, geklassifiseer en beskryf. Morfometriese afmetings van m. piriformis- en n. isciadicus is met behulp van ’n digitale gly-meetpasser gedoen en statisties geanaliseer. Na analise van die verhouding tussen m. piriformis en n. ischiadicus, is bevind dat in 43 (12.65%) van die liggame daar morfologie verskille is, terwyl in 297 (87.35%) van die liggame ‘n normale anatomies patroon vertoon. Daar is bevind dat verskille in morfologie van die strukture hoofsaaklik in die Wit Suid-Afrikaanse bevolkingsgroep voorgekom. Bifurkasie van n. ischiadicus het hoofsaaklik in die popliteale fossa self (79.6%) voorgekom. Die breedte van n. ischiadicus was noemenswaardig groter in die Wit bevolkings groep wat bestudeer is (p <0.05) in vergelyking met die ander twee bevolkings groep is. Die gemiddelde lengte van n. ischiadicus was noemenswaardig langer in die manlike groep (p < 0.05), teenoor die van die vroulik groep. N. ischiadicus gaan gewoonlik as ’n enkele stam die gluteale gebied binne. Die senuwee beweeg inferior tot m. piriformis. Variasies in die anatomie van n. ischiadicus kom algemeen voor. Kennis van hierdie wariasies is klinies belangrik om risiko’s te beperk en om debiliterende beserings of foutiewe diagnose van pyn te voorkom. Ten einde die handhawing van die beste moontlike kliniese praktyk te verseker, vereis dit dat kliniese vaardighede, met betrekking tot akkurate en relevante anatomiese kennis, op ’n konstante basis verfyn word, en gereeld opgedateer word. Dit is om hierdie rede dat studies soos hierdie belangrike bydraes lewer vir die beste kliniese uitkomste. Duidelike, uniforme landmerke vir die morfometriese analise van n. ischiadicus en m. piriformis moet bepaal word om sodoende uniformiteit te verseker. Daarbenewens is daar ook ’n behoefte vir meer gepubliseerde literatuur oor Suid-Afrikaanse bevolkingsgroepe, sodat vergelykings en gevolgtrekkings wat gerapporteer word, ondersteun kan word. Daar is ook ‘n behoefte vir groter studies om beter verteen woordigig van verskillende bevolkings groepe in Suid Afrika te beskryf.af_ZA
dc.description.abstractns201904
dc.format.extent126 pages : illustrationsen_ZA
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch Universityen_ZA
dc.subjectSciatic nerveen_ZA
dc.subjectPiriformisen_ZA
dc.subjectMorphologyen_ZA
dc.subjectGluteal regionen_ZA
dc.subjectBifurcation theoryen_ZA
dc.subjectAnatomyen_ZA
dc.subjectVariationsen_ZA
dc.subjectUCTDen_ZA
dc.titleThe sciatic nerve division in the gluteal region in a South African population: An anatomical studyen_ZA
dc.typeThesisen_ZA
dc.rights.holderStellenbosch Universityen_ZA


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