Manafi Rasi Alireza, Afzal Sina, Baroutkoub Mojtaba, Shakiba Hasan, Kalani Pooya, Tavassoli Mehdi, Zarei Reza
Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Pain Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
Arthroplast Today. 2025 Jan 20;31:101612. doi: 10.1016/j.artd.2024.101612. eCollection 2025 Feb.
Total hip arthroplasty (THA) stands as the standard treatment in neglected developmental dysplasia of the hip (DDH), and its application in severe cases may be linked to debilitating outcomes, including nerve damage. Here, we aimed to report the results of intraoperative nerve monitoring (IONM) via an active method.
In this retrospective cohort study, we recruited patients with Crowe types III and IV DDH, who underwent THA. The study comprised 2 cohorts: one without nerve monitoring and the other with active IONM under epidural anesthesia. The primary study outcomes included the incidence of neural complications, the extent of achieved leg lengthening, and the necessity for femoral osteotomy.
A total of 183 patients were included in this study as the cases underwent THA under epidural anesthesia and IONM, along with 156 historical cohorts of controls. In the group with IONM, no clinically postoperative nerve injury was detected, while in the control group, 6 (3.8%) patients experienced neural complications ( = .08). The mean achieved limb lengthening was significantly greater in the monitoring group as 4.2 cm (range = 2.4-5.6) than in the control group as 3.56 cm (range = 2.2-5.6) ( = .04). The rate of femoral osteotomy was significantly lower in the monitoring group (13.6%, 25/183) compared to the control group (27.5%, 43/156) ( < .005).
The utilization of active IONM in patients under epidural anesthesia during THA for severe DDH proves to be an effective approach. This method allows for real-time assessment of nerve function throughout the surgical procedure, demonstrating its potential to minimize postoperative complications.
全髋关节置换术（THA）是治疗 neglected 型发育性髋关节发育不良（DDH）的标准方法，其在严重病例中的应用可能与包括神经损伤在内的致残性后果有关。在此，我们旨在报告通过一种主动方法进行术中神经监测（IONM）的结果。
在这项回顾性队列研究中，我们招募了接受 THA 的 Crowe III 型和 IV 型 DDH 患者。该研究包括两个队列：一个没有神经监测，另一个在硬膜外麻醉下进行主动 IONM。主要研究结果包括神经并发症的发生率、实现的肢体延长程度以及股骨截骨的必要性。
本研究共纳入 183 例在硬膜外麻醉和 IONM 下接受 THA 的患者，以及 156 例历史对照队列。在 IONM 组中，未检测到临床术后神经损伤，而在对照组中，有 6 例（3.8%）患者出现神经并发症（P = 0.08）。监测组实现的平均肢体延长明显大于对照组，分别为 4.2 cm（范围 = 2.4 - 5.6）和 3.56 cm（范围 = 2.2 - 5.6）（P = 0.04）。监测组的股骨截骨率（13.6%，25/183）明显低于对照组（27.5%，43/156）（P < 0.005）。
在严重 DDH 的 THA 过程中，对硬膜外麻醉下的患者使用主动 IONM 被证明是一种有效的方法。该方法允许在整个手术过程中实时评估神经功能，显示出其将术后并发症降至最低的潜力。
