Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUGI, Strada di Fiume 447, 34149, Trieste, Italy.
J Orthop Traumatol. 2021 Oct 13;22(1):40. doi: 10.1186/s10195-021-00605-8.
Sciatic nerve injury is an uncommon but potentially devastating complication in hip and pelvis surgery. Intraoperative nerve monitoring (IONM) was applied since the seventies in neurosurgery and spine surgery. Nowadays, IONM has gained popularity in other surgical specialities including orthopaedic and trauma surgery. Aim of this systematic review is to resume the literature evidences about the effectiveness of intraoperative monitoring of sciatic nerve during pelvic and hip surgery.
Two reviewers (GC and MD) independently identified studies by a systematic search of PubMed and Google Scholar from inception of database to 10 January 2021. Inclusion criteria were: (a) English written papers, (b) use of any type of intraoperative nerve monitoring during traumatic or elective pelvic and hip surgery, (c) comparison of the outcomes between patients who underwent nerve monitoring and patient who underwent standard procedures, (d) all study types including case reports. The present review was conducted in accordance with the 2009 PRISMA statement.
The literature search produced 224 papers from PubMed and 594 from Google Scholar, with a total amount of 818 papers. The two reviewer excluded 683 papers by title or duplicates. Of the 135 remaining, 72 were excluded after reading the abstract, and 31 by reading the full text. Thus, 32 papers were finally included in the review.
The use of IONM during hip and pelvis surgery is debated. The review results are insufficient to support the routine use of IONM in hip and pelvis surgery. The different IONM techniques have peculiar advantages and disadvantages and differences in sensitivity and specificity without clear evidence of superiority for any. Results from different studies and different interventions are often in contrast. However, there is general agreement in recognizing a role for IONM to define the critical maneuvers, positions or pathologies that could lead to sciatic nerve intraoperative damage.
Level 2.
坐骨神经损伤是髋关节和骨盆手术中一种罕见但潜在的灾难性并发症。术中神经监测（IONM）自 70 年代以来就在神经外科和脊柱外科中得到应用。如今，IONM 在包括骨科和创伤外科在内的其他外科专业中已经得到普及。本系统评价的目的是总结关于在骨盆和髋关节手术中监测坐骨神经的术中监测的文献证据。
两名审查员（GC 和 MD）通过系统地搜索 PubMed 和 Google Scholar，从数据库建立到 2021 年 1 月 10 日，独立地确定了研究。纳入标准为：（a）英文论文，（b）在创伤性或择期骨盆和髋关节手术中使用任何类型的术中神经监测，（c）比较接受神经监测的患者与接受标准程序的患者的结果，（d）所有研究类型，包括病例报告。本综述是根据 2009 年 PRISMA 声明进行的。
从 PubMed 检索到 224 篇文献，从 Google Scholar 检索到 594 篇文献，总共 818 篇文献。两名审查员通过标题或重复排除了 683 篇文献。在剩余的 135 篇文献中，有 72 篇在阅读摘要后被排除，31 篇在阅读全文后被排除。因此，最终有 32 篇文献被纳入综述。
在髋关节和骨盆手术中使用 IONM 存在争议。综述结果不足以支持在髋关节和骨盆手术中常规使用 IONM。不同的 IONM 技术具有独特的优缺点，在敏感性和特异性方面存在差异，目前尚无任何一种技术具有明显优势。来自不同研究和不同干预措施的结果往往相互矛盾。然而，人们普遍一致认为，IONM 可用于确定可能导致坐骨神经术中损伤的关键操作、位置或病理。
2 级。
