Siliski J M, Scott R D
J Bone Joint Surg Am. 1985 Oct;67(8):1225-8.
Obturator neuropathy is an infrequently identified complication of total hip replacement that may cause debilitating pain. There have been isolated reports of this complication in the literature, but only one case has been published in which intrapelvic cement was the causative agent. We are describing the cases of four patients with obturator neuropathy after total hip replacement, documented by electromyography and attributed to intrapelvic extension of cement. In each patient the source of the symptoms was not initially apparent. In three of the patients the extruded cement and obturator nerve were explored surgically. One of the three patients was improved by obturator neurectomy. Of the other two patients, both treated by excision of cement, only one was improved. The fourth patient was not treated. Persistent pain in the groin and thigh, intrapelvic cement visible on plain roentgenograms, and adductor weakness after total hip replacement suggest that this complication has occurred. Electromyography can confirm the presence of obturator neuropathy. Based on this limited series, excision of the extruded cement and preservation of the nerve should be attempted only when the nerve is grossly normal and functional as determined by electrical stimulation at the time of surgical exploration; otherwise, obturator neurectomy should be considered.
闭孔神经病变是全髋关节置换术一种罕见的并发症，可能导致使人衰弱的疼痛。文献中有关于该并发症的个别报道，但仅有一例报道指出盆腔内骨水泥是致病因素。我们现描述4例全髋关节置换术后发生闭孔神经病变的病例，经肌电图证实，病因是骨水泥向盆腔内延伸。在每位患者中，症状的根源最初并不明显。其中3例患者接受了手术探查，以清除挤出的骨水泥和探查闭孔神经。3例患者中有1例通过闭孔神经切除术症状得到改善。另外2例均接受了骨水泥清除术，只有1例症状改善。第4例患者未接受治疗。全髋关节置换术后腹股沟和大腿持续疼痛、X线平片显示盆腔内有骨水泥以及内收肌无力提示可能发生了这种并发症。肌电图可证实闭孔神经病变的存在。基于这一有限的病例系列，只有在手术探查时通过电刺激确定神经大体正常且功能正常的情况下，才应尝试清除挤出的骨水泥并保留神经；否则，应考虑行闭孔神经切除术。
