Siebenrock K A, Rösler K M, Gonzalez E, Ganz R
Department of Orthopaedic Surgery, University of Berne, Switzerland.
J Arthroplasty. 2000 Oct;15(7):867-70. doi: 10.1054/arth.2000.8099.
The purpose of this study was to evaluate the incidence of intraoperative superior gluteal nerve irritation and to identify specific surgical maneuvers that may harm the nerve. Continuous intraoperative electromyography (EMG) monitoring of the superior gluteal nerve-innervated muscles (gluteus medius and tensor fascia lata muscles) was performed in 12 patients undergoing total hip arthroplasty. A modified lateral approach was used, including a partial anterior osteotomy of the greater trochanter with splitting of the gluteus medius and vastus lateralis muscles. All patients had a clinical follow-up examination 1 year postoperatively to evaluate abductor muscle function. Irritation of the nerve occurred first during splitting of the gluteus medius muscle, then with increased gluteus medius retraction for exposure of the acetabulum, and finally during positioning of the leg for preparation of the femur. The detected EMG alterations were important because they were found in a single patient with persistent abductor muscle weakness.
本研究的目的是评估术中臀上神经受刺激的发生率，并确定可能损伤该神经的特定手术操作。对12例行全髋关节置换术的患者进行了术中连续肌电图（EMG）监测臀上神经支配的肌肉（臀中肌和阔筋膜张肌）。采用改良外侧入路，包括大转子部分前截骨并劈开臀中肌和股外侧肌。所有患者术后1年进行临床随访检查以评估外展肌功能。神经受刺激首先发生在劈开臀中肌时，然后随着为暴露髋臼而增加臀中肌的牵开，最后在为准备股骨而摆放腿部位置时。检测到的肌电图改变很重要，因为在一名存在持续性外展肌无力的患者中发现了这些改变。
