Department of Orthopaedics and Traumatology, Turan Turan Health Group, Bursa, Türkiye.
Clin Orthop Surg. 2023 Oct;15(5):711-717. doi: 10.4055/cios22371. Epub 2023 Aug 8.
Crowe types 3 and 4 dysplastic hips usually need total hip arthroplasty (THA) with femoral shortening osteotomy (FSO) to facilitate reduction, equalize limb length, and decrease the traction stress in nerves. The frequency of peripheral nerve palsy after primary THA has been reported to range from 0.08% to 3.7%. Apart from direct trauma to the nerve, the excessive extension of the extremity is also reported as a common cause of nerve damage. The current study aimed to evaluate the outcomes of intraoperative neurophysiological monitoring (IONM) in THA for Crowe types 3 and 4 hips.
The data of patients who underwent primary THA with IONM were retrospectively reviewed using our medical records. Patients with Crowe types 3 and 4 dysplastic hips were included in the study. Motor-evoked potentials and somatosensory-evoked potentials were assessed intraoperatively. Preoperative dislocation height and postoperative trochanter minor differences were measured using preoperative and postoperative radiographs.
Twenty-three hips of 19 patients (4 bilateral THAs) with a mean age of 45 years participated in the study. Ten hips (43%) were classified as Crowe type 4, whereas 13 hips (57%) were Crowe type 3. The mean preoperative dislocation height was 41.6 mm (range, 15-100 mm). Postoperatively, only 6 patients had a difference between trochanter minor levels with a mean of 8.5 mm (range, 3-17 mm). Three patients underwent a subtrochanteric FSO to achieve reduction. Postoperatively, no patient had any motor and sensory nerve dysfunction.
According to the results acquired from this study, no nerve palsy was observed after THA for Crowe types 3 and 4 hips, and subtrochanteric FSO was not performed in all Crowe type 3 hips and 70% of Crowe type 4 hips with the aid of IONM.
Crowe 分型 3 和 4 型发育不良的髋关节通常需要全髋关节置换术（THA）联合股骨短缩截骨术（FSO），以方便复位、均衡肢体长度并减少神经的牵引应力。初次 THA 后发生周围神经麻痹的频率报道范围为 0.08%至 3.7%。除了神经的直接创伤外，肢体的过度伸展也被报道为神经损伤的常见原因。本研究旨在评估术中神经生理监测（IONM）在 Crowe 分型 3 和 4 型髋关节 THA 中的应用效果。
我们通过病历回顾了接受过 IONM 指导的初次 THA 患者的数据。本研究纳入 Crowe 分型 3 和 4 型发育不良髋关节患者。术中评估运动诱发电位和体感诱发电位。使用术前和术后 X 线片测量术前脱位高度和术后小粗隆差异。
本研究共纳入 19 例患者（4 例双侧 THA）的 23 髋，平均年龄为 45 岁。10 髋（43%）为 Crowe 分型 4，13 髋（57%）为 Crowe 分型 3。术前脱位高度平均为 41.6mm（范围，15-100mm）。术后，仅 6 例小粗隆水平有差异，平均为 8.5mm（范围，3-17mm）。3 例患者行股骨小转子下 FSO 以实现复位。术后，所有患者均未出现运动和感觉神经功能障碍。
根据本研究结果，Crowe 分型 3 和 4 型髋关节 THA 后未观察到神经麻痹，在 IONM 辅助下，所有 Crowe 分型 3 髋和 70%Crowe 分型 4 髋均未行股骨小转子下 FSO。
