University of California San Francisco, School of Medicine, San Francisco, CA, USA.
Department of Orthopaedic Surgery, CoRSU Rehabilitation Hospital, Kisubi, Uganda.
BMC Musculoskelet Disord. 2022 Aug 5;23(1):754. doi: 10.1186/s12891-022-05664-4.
Post-injection paralysis (PIP) of the sciatic nerve is an iatrogenic paralysis that occurs after an intramuscular injection, with resultant foot deformity and disability. This study investigates the epidemiology and treatment of PIP in Uganda.
Health records of pediatric patients surgically treated for PIP at the CoRSU Rehabilitation Hospital from 2013 to 2018 were retrospectively reviewed. Pre-operative demographics, perioperative management, and outcomes were coded and analyzed with descriptive statistics, chi-square for categorical variables, and linear models for continuous variables.
Four-hundred and two pediatric patients underwent 491 total procedures. Eighty-three percent of reported injection indications were for febrile illness. Twenty-five percent of reported injections explicitly identified quinine as the agent. Although ten different procedures were performed, achilles tendon lengthening, triple arthrodesis, tibialis posterior and anterior tendon transfers composed 83% of all conducted surgeries. Amongst five different foot deformities, equinus and varus were most likely to undergo soft tissue and bony procedures, respectively (p=0.0223). Ninteen percent of patients received two or more surgeries. Sixty-seven percent of patients achieved a plantigrade outcome; 13.61% had not by the end of the study period; 19.3% had unreported outcomes. Those who lived further from the facility had longer times between the inciting injection and initial hospital presentation (p=0.0216) and were more likely to be lost to follow-up (p=0.0042).
PIP is a serious iatrogenic disability. Prevention strategies are imperative, as over 400 children required 491 total surgical procedures within just six years at one hospital in Uganda.
坐骨神经注射后瘫痪（PIP）是一种医源性瘫痪，发生在肌肉内注射后，导致足部畸形和残疾。本研究调查了乌干达 PIP 的流行病学和治疗情况。
回顾性分析了 2013 年至 2018 年在 CoRSU 康复医院接受手术治疗 PIP 的儿科患者的医疗记录。对术前人口统计学、围手术期管理和结果进行编码，并使用描述性统计、分类变量的卡方检验和连续变量的线性模型进行分析。
402 名儿科患者共接受 491 次手术。报告的注射适应症 83%为发热性疾病。25%的报告注射明确指出奎宁为药物。虽然进行了十种不同的手术，但跟腱延长术、三关节融合术、胫后肌和前肌肌腱转移术占所有手术的 83%。在五种不同的足畸形中，马蹄内翻和内翻畸形最有可能分别接受软组织和骨手术（p=0.0223）。19%的患者接受了两次或更多次手术。67%的患者获得了足底负重的结果；13.61%在研究结束时仍未达到；19.3%的患者没有报告结果。那些离医院较远的患者，从引发注射到首次就诊的时间间隔较长（p=0.0216），且更有可能失访（p=0.0042）。
PIP 是一种严重的医源性残疾。预防策略至关重要，因为在乌干达的一家医院，仅在六年内就有 400 多名儿童需要进行 491 次总手术。
