Schuh A, Dürr V, Weier H, Zeiler G, Winterholler M
Orthopädische Klinik Rummelsberg, Schwarzenbruck.
Orthopade. 2004 Jul;33(7):836-40. doi: 10.1007/s00132-004-0652-1.
Delayed lesions of the femoral or sciatic nerve are a rare complication after total hip arthroplasty. Several cases in association with cement edges, scar tissue, broken cerclages, deep hematoma, or reinforcement rings have been published. We report about a 62-year-old female who developed a pure motor paresis of the quadriceps muscle 2 weeks after total hip arthroplasty. After electrophysiological evaluation had revealed an isolated femoral nerve lesion, revision of the femoral nerve was performed. During operative revision no pathologic findings could be seen. One week later the patient developed paralysis of the left wrist and finger extensors after using crutches. Electrophysiological evaluation revealed several nerve conduction blocks in physiological entrapments and the diagnosis of hereditary neuropathy with liability to pressure palsies (HNPP) was established. Hereditary neuropathy with liability to pressure palsies (HNPP) is a rare disease with increased vulnerability of the peripheral nerve system with mostly reversible sensorimotor deficits. It should be taken into consideration in cases of atypical findings of compression syndromes of peripheral nerves or delayed neuropathy, e. g., after total hip arthroplasty.
股神经或坐骨神经的迟发性损伤是全髋关节置换术后罕见的并发症。已有多例与骨水泥边缘、瘢痕组织、断裂的环扎带、深部血肿或加强环相关的病例报道。我们报告了一名62岁女性，在全髋关节置换术后2周出现股四头肌单纯运动性麻痹。电生理评估显示为孤立性股神经损伤后，对股神经进行了翻修手术。手术翻修过程中未见病理改变。一周后，患者在使用拐杖后出现左手腕和手指伸肌麻痹。电生理评估显示在生理性卡压部位有多处神经传导阻滞，确诊为遗传性压力易感性周围神经病（HNPP）。遗传性压力易感性周围神经病（HNPP）是一种罕见疾病，其周围神经系统易损性增加，大多为可逆性感觉运动功能缺损。在周围神经压迫综合征或迟发性神经病出现非典型表现的病例中，如全髋关节置换术后，应考虑到该病。
