Zwolak Pawel, Eysel Peer, William-Patrick Michael Joern
Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany.
Orthop Rev (Pavia). 2011 Mar 17;3(1):e6. doi: 10.4081/or.2011.e6.
Cement extrusion into the pelvis with subsequent palsy of the obturator and femoral nerves is a rare entity after hip replacement surgery. Cemented fixation of the acetabular cup has been considered as a safe and reliable standard procedure with very good long term results. We present a case of fifty year old female patient after hip arthroplasty procedure which suffered an obturator and femoral nerve palsy caused by extrusion of bone cement into the pelvis. Postoperative X-rays and CT-scan of the pelvis demonstrated a huge mass consisted of bone cement in close proximity of femoral and obturator nerves. The surgery charts reported shallow and weak bony substance in postero-superior aspect of the acetabulum. This weak bony acetabular substance may have caused extrusion of bone cement during press-fitting of the polyethylene cup into the acetabulum, and the following damage of the both nerves produced by polymerization of bone cement. The bone cement fragment has been surgically removed 3 weeks after arthroplasty. The female patient underwent intensive postoperative physical therapy and electro stimulation which resulted in full recovery of the patient to daily routine and almost normal electromyography results.
髋关节置换术后骨水泥挤入骨盆并继发闭孔神经和股神经麻痹是一种罕见的情况。髋臼杯的骨水泥固定一直被认为是一种安全可靠的标准手术，长期效果良好。我们报告一例50岁女性患者，在髋关节置换术后因骨水泥挤入骨盆而出现闭孔神经和股神经麻痹。术后骨盆的X线和CT扫描显示在股神经和闭孔神经附近有一个由骨水泥组成的巨大肿块。手术记录报告髋臼后上缘骨质浅而薄弱。这种髋臼骨质薄弱可能在将聚乙烯杯压入髋臼时导致骨水泥挤出，随后骨水泥聚合对两条神经造成损伤。骨水泥碎片在关节置换术后3周通过手术取出。该女性患者术后接受了强化物理治疗和电刺激，最终完全恢复了日常生活，肌电图结果几乎正常。
