Macheras George A, Christofilopoulos Panayiotis, Lepetsos Panagiotis, Leonidou Andreas O, Anastasopoulos Panagiotis P, Galanakos Spyridon P
4 Department of Orthopaedics and Trauma, KAT Hospital, Athens - Greece.
Department of Surgery, Orthopaedic Surgery and Traumatology of the locomotor System, University Hospitals of Geneva, Geneva - Switzerland.
Hip Int. 2016 Jul 25;26(4):338-43. doi: 10.5301/hipint.5000352. Epub 2016 Apr 13.
Minimal invasive techniques in total hip arthroplasty (THA) have become increasingly popular during recent years. Despite much debate over the outcome of several minimal invasive techniques, complications arising from the use of anterior minimally invasive surgery (AMIS) for THA on a traction table are not well documented. Our study aims to focus on nerve damage during the AMIS procedure and the possible explanations of these injuries.
We reviewed all primary THAs performed with the AMIS technique using a traction table, over 5 years and recorded all intraoperative and postoperative complications up to the latest follow-up. We focused on nerve injuries and nerve function impairment following the aforementioned technique.
Our study included 1,512 THAs performed with the AMIS technique in 2 major hip reconstruction centres (KAT General Hospital, Athens, Greece and University Hospital of Geneva, Switzerland), on 1,238 patients (985 women, 253 men; mean age 65.24 years). Mean follow-up was 29.4 months. We observed 51 cases of transient lateral femoral cutaneous nerve neuropraxia (3.37%), 4 cases of femoral nerve paralysis (3 permanent, 1 transient [0.26%]) and 1 case of permanent sciatic nerve paralysis (0.06%). No case of obturator or pudendal nerve injury was noticed. Mean age of these cases was 68.97 years. Sciatic and femoral nerve injuries were confirmed by electromyography, showing axonotmesis of the damaged nerve.
Neurological injuries are a rare but distinct complication of THAs using the AMIS technique. Possible explanations for such referred nerve injuries are direct nerve injury, extreme traction, hyperextension, extreme external rotation of the leg, use of retractors and coexisting spinal deformities. Controlled use of traction in hip extension, cautious use of retractors and potential use of dynamometers may be useful, so that neurological damage can be avoided. Further studies are needed to fully elucidate the role of the above factors in AMIS neurological complications.
近年来，全髋关节置换术（THA）中的微创技术越来越受欢迎。尽管对几种微创技术的结果存在诸多争议，但在牵引台上使用前路微创手术（AMIS）进行THA所引发的并发症尚无充分记录。我们的研究旨在关注AMIS手术过程中的神经损伤以及这些损伤的可能原因。
我们回顾了在5年多时间里使用牵引台通过AMIS技术进行的所有初次THA手术，并记录了直至最新随访时的所有术中及术后并发症。我们重点关注上述技术后的神经损伤和神经功能损害。
我们的研究纳入了在2个主要髋关节重建中心（希腊雅典的KAT综合医院和瑞士日内瓦大学医院）对1238例患者（985名女性，253名男性；平均年龄65.24岁）进行的1512例采用AMIS技术的THA手术。平均随访时间为29.4个月。我们观察到51例股外侧皮神经暂时性神经失用（3.37%），4例股神经麻痹（3例永久性，1例暂时性[0.26%]），以及1例永久性坐骨神经麻痹（0.06%）。未发现闭孔神经或阴部神经损伤病例。这些病例的平均年龄为68.97岁。坐骨神经和股神经损伤通过肌电图得到证实，显示受损神经存在轴索断裂。
神经损伤是采用AMIS技术进行THA手术时罕见但明显的并发症。此类牵涉性神经损伤的可能原因包括直接神经损伤、过度牵引、过度伸展、腿部极度外旋、使用牵开器以及并存的脊柱畸形。在髋关节伸展时控制牵引的使用、谨慎使用牵开器以及可能使用测力计可能会有所帮助，从而避免神经损伤。需要进一步研究以充分阐明上述因素在AMIS神经并发症中的作用。
