Objectives: To observe the possibility of enlarging the greater sciatic notch by illium
osteotomy through the posterior gluteal approach for reaching the intrapelvic upper sacral plexus as well as the covergence level of sacral plexus,and performing the nerve graft for surgical repairing the sacral plexus ruptured
injuries or sacral plexus nerve
tumor resection. Methods: The clinical data of 10 patients with sacral plexus injury or sacral plexus nerve
tumor underwent the surgical operation via the expanded greater sciatic notch at Department of Hand Surgery,Beijing Jishuitan Hospital from July 2016 to November 2020 were retrospectively analyzed.There were 4 male and 6 female patients,with an age of (38.0±9.3)years (range:26 to 56 years).There were 8 cases with sacral plexus injury at the intrapelvic or covergence level (deep to the piriformis). Out of this 8 cases,4 cases with intrapelvic pan-sacral plexus injury,1 case with upper sacral plexus injury and 3 cases with convergence level pan sacral plexus injury.Another 2 cases were sacral plexus
neoplasm.The average time from injury or onset to operation was 10.4 months (range:1.5 to 60.0 months). All cases were performed surgery for reaching the intrapelvic upper sacral plexus as well as the covergence level of sacral plexus with enlarging the greater sciatic notch by illium
osteotomy through the posterior gluteal approach.Intraoperation the sacral plexus ruptured injurie was repaired and the sacral plexus nerve
tumor was resected.Intraoperative findings,postoperative complications and healing of patients were recorded. Results: All the 10 patients underwent the sacral plexus surgical exploration and cutaneous nerve graft for sacral plexus nerve repairing or neurolysis or
neoplasm resection through the posterior gluteal approach successfully.The length and width of illium
osteotomy mass were (2.9±0.4)cm (range:2.5 to 3.8 cm) and (2.5±0.5)cm (range:1.5 to 3.4 cm) respectively.The median intraoperative
bleeding volume was (M(QR))800(800)ml (range:400 to 2 000 ml).There were no complication with major
vascular injury and
hematoma formation,and all incisions healed.The postoperative follow-up was 29.8 months (range:1.5 to 54.0 months).Nine cases of iliac
osteotomy were healed,and 1 case was not healed because the follow-up was only 1.5 months. Conclusions: The intrapelvic upper sacral plexus and the convergence level of sacral plexus deep to the piriformis can be exposed clearly through this posterior gluteal approach via illium
osteotomy for enlarging the greater sciatic notch,and there was enough operative space that surgical exploration and nerve graft or
nerve transfer or
neoplasm resection can be performed.