Wasielewski R C, Crossett L S, Rubash H E
Department of Orthopaedic Surgery, University of Pittsburgh, Pennsylvania.
Orthop Clin North Am. 1992 Apr;23(2):219-35.
Complete awareness of the anatomy of the pelvis and proximal femur is required if neurologic and vascular complications are to be avoided following total hip arthroplasty. Avoidance of the anterior quadrants for acetabular screw fixation is critical. Cementing techniques are important, and all acetabular and femoral defects should be bone grafted to avoid inadvertent cement migration. Knowledge of the location of pertinent neural and vascular structures should guide retractor placement. Planned lengthening of an extremity during total hip arthroplasty poses a significant risk to neurologic structures, and SSEP monitoring should be considered. In difficult revision procedures and complex primary total hip arthroplasty, preoperative neural and vascular assessment and SSEP monitoring should be done. With the occurrence of a postoperative nerve palsy, careful review of the procedure should be performed to determine the cause of the injury. In this manner the surgeon can best offer appropriate counseling to the patient as to the likelihood of neurologic recovery.
如果要在全髋关节置换术后避免神经和血管并发症，就需要全面了解骨盆和股骨近端的解剖结构。避免在前象限进行髋臼螺钉固定至关重要。骨水泥技术很重要，所有髋臼和股骨缺损都应进行植骨，以避免骨水泥意外移位。了解相关神经和血管结构的位置应指导牵开器的放置。全髋关节置换术中计划延长肢体对神经结构构成重大风险，应考虑进行体感诱发电位（SSEP）监测。在困难的翻修手术和复杂的初次全髋关节置换术中，应进行术前神经和血管评估以及SSEP监测。术后出现神经麻痹时，应仔细回顾手术过程以确定损伤原因。通过这种方式，外科医生可以最好地就神经恢复的可能性向患者提供适当的咨询。
