Sutter M, Hersche O, Leunig M, Guggi T, Dvorak J, Eggspuehler A
Schulthess Clinic, Lengghalde 2, Zurich 8008, Switzerland.
J Bone Joint Surg Br. 2012 Feb;94(2):179-84. doi: 10.1302/0301-620X.94B2.28019.
Peripheral nerve injury is an uncommon but serious complication of hip surgery that can adversely affect the outcome. Several studies have described the use of electromyography and intra-operative sensory evoked potentials for early warning of nerve injury. We assessed the results of multimodal intra-operative monitoring during complex hip surgery. We retrospectively analysed data collected between 2001 and 2010 from 69 patients who underwent complex hip surgery by a single surgeon using multimodal intra-operative monitoring from a total pool of 7894 patients who underwent hip surgery during this period. In 24 (35%) procedures the surgeon was alerted to a possible lesion to the sciatic and/or femoral nerve. Alerts were observed most frequently during peri-acetabular osteotomy. The surgeon adapted his approach based on interpretation of the neurophysiological changes. From 69 monitored surgical procedures, there was only one true positive case of post-operative nerve injury. There were no false positives or false negatives, and the remaining 68 cases were all true negative. The sensitivity for predicting post-operative nerve injury was 100% and the specificity 100%. We conclude that it is possible and appropriate to use this method during complex hip surgery and it is effective for alerting the surgeon to the possibility of nerve injury.
周围神经损伤是髋关节手术中一种罕见但严重的并发症，会对手术结果产生不利影响。多项研究描述了使用肌电图和术中感觉诱发电位来早期预警神经损伤。我们评估了复杂髋关节手术期间多模式术中监测的结果。我们回顾性分析了2001年至2010年间从7894例接受髋关节手术的患者中选取的69例由单一外科医生进行复杂髋关节手术并使用多模式术中监测的患者的数据。在24例（35%）手术中，外科医生收到了关于坐骨神经和/或股神经可能受损的警报。警报最常出现在髋臼周围截骨术期间。外科医生根据对神经生理变化的解读调整了手术方法。在69例监测的手术中，术后神经损伤仅有1例假阳性病例。没有假阳性或假阴性情况，其余68例均为真阴性。预测术后神经损伤的敏感性为100%，特异性为100%。我们得出结论，在复杂髋关节手术期间使用这种方法是可行且合适的，并且对于提醒外科医生注意神经损伤的可能性是有效的。
