Takeda Shinsuke, Yamamoto Michiro, Tanaka Yoshihiro, Mitsuya So, Yamauchi Ken-Ichi, Hirata Hitoshi
Trauma and Microsurgery Center, Toyohashi Municipal Hospital, Toyohashi, Japan.
Department of Orthopedic Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan.
Nagoya J Med Sci. 2023 Aug;85(3):569-578. doi: 10.18999/nagjms.85.3.569.
Although anterior subcutaneous pelvic internal fixation is a valuable tool for the reduction and fixation of unstable pelvic ring injuries, lateral femoral cutaneous nerve irritation by the implant is the most common complication. This study aimed to investigate the association between the nerve-to-implant distance and the postoperative lateral femoral cutaneous nerve symptom. Patients who underwent anterior subcutaneous pelvic internal fixation between 2016 and 2019 were retrospectively analyzed. Lateral femoral cutaneous nerve status was defined as follows: not identified, nerve-to-implant distance <13 mm, and ≥13 mm. The proportion of patients who experienced postoperative nerve disorders was compared using the nerve status. Nerve-to-implant distances were compared using the presence or absence of postoperative lateral femoral cutaneous nerve disorders. The predictive value of a nerve-to-implant distance of 13 mm for postoperative nerve disorders was assessed. Overall, 26 lateral femoral cutaneous nerves were included. Ten patients had postoperative nerve disorders, of which seven had an nerve-to-implant distance <13 mm, while the other three occurred in patients whose nerves were not identified. A nerve-to-implant distance ≥13 mm was significantly associated with a decreased risk of postoperative nerve disorder compared to a nerve-to-implant distance <13 mm (p = 0.017). A nerve-to-implant distance ≥13 mm had a perfect sensitivity (100%) and modest specificity (58.3%). Nerve-to-implant distance was ≥13 mm. Nerve disorders were frequently observed when the nerve-to-implant distance was <13 mm or the nerve was not identified intraoperatively. Efforts to identify the lateral femoral cutaneous nerve may be useful to avoid internal fixation-related nerve disorders.
尽管前路皮下骨盆内固定是治疗不稳定骨盆环损伤的复位与固定的重要手段，但植入物刺激股外侧皮神经是最常见的并发症。本研究旨在探讨神经与植入物距离和术后股外侧皮神经症状之间的关联。回顾性分析2016年至2019年间接受前路皮下骨盆内固定的患者。股外侧皮神经状态定义如下：未识别、神经与植入物距离<13 mm和≥13 mm。根据神经状态比较术后出现神经功能障碍的患者比例。根据术后是否出现股外侧皮神经功能障碍比较神经与植入物距离。评估神经与植入物距离为13 mm对术后神经功能障碍的预测价值。总共纳入了26条股外侧皮神经。10例患者出现术后神经功能障碍，其中7例神经与植入物距离<13 mm，另外3例发生在未识别出神经的患者中。与神经与植入物距离<13 mm相比，神经与植入物距离≥13 mm与术后神经功能障碍风险降低显著相关（p = 0.017）。神经与植入物距离≥13 mm具有完美的敏感性（1）和中等的特异性（58.3%）。神经与植入物距离≥13 mm。当神经与植入物距离<13 mm或术中未识别出神经时，经常观察到神经功能障碍。识别股外侧皮神经的努力可能有助于避免与内固定相关的神经功能障碍。
