Sanders Austin E, Andras Lindsay M, Choi Paul D, Tolo Vernon T, Skaggs David L
Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
Spine (Phila Pa 1976). 2016 Oct 1;41(19):E1164-E1167. doi: 10.1097/BRS.0000000000001574.
Prospective study of consecutive patients.
The purpose of the study was to evaluate the incidence, risk factors, and time to resolution of lateral femoral cutaneous nerve palsy (LFCNP) after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).
No prior studies have prospectively evaluated the prevalence of LFCNP exclusively in the treatment of AIS.
Between June 2014 and May 2015, patients undergoing PSF for AIS were examined preoperatively, postoperatively, and at follow-up clinic visits until the resolution of the LFCNP. All neurologic examinations were performed by attending pediatric orthopedic surgeons. Patients who underwent staged, revision or anterior procedures, had preoperative neurologic deficits or neuropathy, were excluded.
A total of 55 patients with an average age of 14 years (10-21) were enrolled. Twenty-five percent (14/55) of patients had a postoperative LFCNP. There were no other postoperative neurologic deficits. Of the 14 patients with an LFCNP, 57% of these were bilateral. Fourteen percent (2/14) of these patients had absent sensation to light touch, whereas 85% (12/14) had decreased sensation. No patients reported experiencing pain associated with the LFCNP or tenderness when the anterolateral thigh was palpated. The LFCNP did not limit postoperative mobilization or prolong hospital stay. The LFCNP was noted to resolve in an average of 3.6 days (1-18); 6/14 (43%) resolved after 1 day. No correlation was observed between occurrence of LFCNP and sex, age, height, body mass index, length of fusion, Cobb angle, or blood loss. The occurrence of LFCNP was associated with heavier weight (P = 0.032) and longer operative times (P = 0.016). Resolution of the LFCNP was associated with longer operative time (P = 0.010).
LFCNP occurred in 25% of AIS patients undergoing PSF. Risk of LFCNP increased with longer operative times and heavier patient weight. On average, LFCNP resolved in less than 4 days and did not cause any pain or limitations.
对连续患者进行前瞻性研究。
本研究旨在评估青少年特发性脊柱侧凸（AIS）后路脊柱融合术（PSF）后股外侧皮神经麻痹（LFCNP）的发生率、危险因素及恢复时间。
此前尚无研究专门对AIS治疗中LFCNP的患病率进行前瞻性评估。
在2014年6月至2015年5月期间，对接受AIS的PSF治疗的患者在术前、术后及随访门诊进行检查，直至LFCNP恢复。所有神经学检查均由小儿骨科主治医生进行。排除接受分期、翻修或前路手术、术前有神经功能缺损或神经病变的患者。
共纳入55例平均年龄14岁（10 - 21岁）的患者。25%（14/55）的患者术后发生LFCNP。无其他术后神经功能缺损。在14例发生LFCNP的患者中，57%为双侧。其中14%（2/14）的患者对轻触觉无感觉，而85%（12/14）感觉减退。无患者报告与LFCNP相关的疼痛或在前外侧大腿触诊时有压痛。LFCNP未限制术后活动或延长住院时间。LFCNP平均在3.6天（1 - 18天）内恢复；6/14（43%）在1天后恢复。未观察到LFCNP的发生与性别、年龄、身高、体重指数、融合长度、Cobb角或失血量之间存在相关性。LFCNP的发生与体重较重（P = 0.032）和手术时间较长（P = 0.016）相关。LFCNP的恢复与手术时间较长（P = 0.010）相关。
接受PSF治疗的AIS患者中25%发生LFCNP。LFCNP的风险随手术时间延长和患者体重增加而增加。平均而言，LFCNP在不到4天内恢复，且未引起任何疼痛或功能受限。
2级。
