Fanning James, Carol Tiffany, Miller Dawn, Flora Robert
Department of Obstetrics and Gynecology, Summa Health System, Northeastern Ohio Universities College of Medicine, Akron 44309, USA.
J Reprod Med. 2007 Apr;52(4):285-8.
To review the diagnosis and treatment of postoperative femoral motor neuropathy without neurologic consultation or testing.
A retrospective review of 6 consecutive patients with postoperative femoral motor neuropathy following gynecologic surgery. Diagnosis was made on clinical evaluation: history of falling during postoperative ambulation, quadriceps weakness, straight leg raise weakness, diminished knee jerk response, and no evidence of psoas hematoma or abscess. Neurologic consultation, electromyography, nerve conduction study and radiologic imaging, such as computed tomography, were not obtained. Instead, a physical therapy consultation was obtained for a knee orthotic and rehabilitation.
Four postoperative femoral motor neuropathies developed following 3,014 cases of major gynecologic surgery (0.1%). Two additional cases were seen in consultation. The median age was 57 years. All patients fell while attempting ambulation on postoperative day 1. Recovery occurred at a median of 3 months (1-4). At a median follow-up of 4 years, no patient had developed additional neurologic sequelae. A history of prior postoperative femoral motor neuropathy was noted in 2 of 6 patients (33%).
This was the first study of diagnosis and treatment of postoperative femoral motor neuropathy following gynecologic surgery without neurologic consultation or testing. Because of the significant expense of neurologic consultation and testing, patients with postoperative femoral motor neuropathy can have the condition diagnosed by the gynecologist and be referred directly to physical therapy without adversely affecting outcome. This also was the first study to elicit a prior history offemoral neuropathy in 33% of patients. Thus, a prior history may be a risk factor for recurrence.
回顾未经神经科会诊或检查的术后股神经运动神经病的诊断与治疗。
对6例妇科手术后发生股神经运动神经病的患者进行回顾性研究。通过临床评估做出诊断：术后行走时跌倒史、股四头肌无力、直腿抬高无力、膝反射减弱，且无腰大肌血肿或脓肿的证据。未进行神经科会诊、肌电图检查、神经传导研究及影像学检查，如计算机断层扫描。而是获得了物理治疗会诊以定制膝关节矫形器并进行康复治疗。
在3014例大型妇科手术后发生了4例术后股神经运动神经病（0.1%）。另外会诊中发现2例。中位年龄为57岁。所有患者在术后第1天尝试行走时均跌倒。恢复中位时间为3个月（1 - 4个月）。中位随访4年时，无患者出现其他神经后遗症。6例患者中有2例（33%）有既往术后股神经运动神经病病史。
这是第一项关于未经神经科会诊或检查的妇科手术后股神经运动神经病诊断与治疗的研究。由于神经科会诊和检查费用高昂，术后股神经运动神经病患者可由妇科医生诊断病情，并直接转诊至物理治疗，而不会对预后产生不利影响。这也是第一项发现33%的患者有既往股神经病变病史的研究。因此，既往病史可能是复发的危险因素。
