Weale A E, Newman P, Ferguson I T, Bannister G C
Southmead Hospital, Westbury-on-Trym, Bristol, UK.
J Bone Joint Surg Br. 1996 Nov;78(6):899-902. doi: 10.1302/0301-620x78b6.6603.
Nerve injury is a rare complication of total hip replacement which may be related to the exposure used for the operation. The posterior approach is traditionally associated with injury to the sciatic nerve. We have compared the incidence of nerve injury after primary total hip replacement (THR) using either a posterior or a direct lateral approach. We studied 42 consecutive patients undergoing primary total hip replacement. The surgeons used a posterior (22 patients) or direct lateral (20 patients) approach in accordance with their normal practice. The obturator, femoral, posterior tibial and common peroneal nerves were assessed clinically and electrophysiologically by electromyography (EMG) and measurement of the velocity of nerve conduction before operation and at four weeks after. All patients were free from symptoms of nerve injury after operation but five lesions were identified in four patients by the electrophysiological studies; the obturator nerve was involved in two, the femoral in one, the common peroneal in one and the posterior tibial in one. All these injuries occurred using the lateral approach. Clinical assessment alone underestimates the incidence of nerve injury complicating THR. Our study does not confirm the association of nerve injury with the posterior approach which had been described previously.
神经损伤是全髋关节置换术的一种罕见并发症，可能与手术所采用的暴露方式有关。传统上，后入路与坐骨神经损伤相关。我们比较了采用后入路或直接外侧入路进行初次全髋关节置换术（THR）后神经损伤的发生率。我们研究了42例连续接受初次全髋关节置换术的患者。外科医生根据其常规做法采用后入路（22例患者）或直接外侧入路（20例患者）。术前及术后四周通过肌电图（EMG）及神经传导速度测量对闭孔神经、股神经、胫后神经和腓总神经进行临床及电生理评估。所有患者术后均无神经损伤症状，但通过电生理研究在4例患者中发现了5处损伤；其中闭孔神经2处、股神经1处、腓总神经1处、胫后神经1处。所有这些损伤均发生在采用外侧入路时。仅靠临床评估会低估全髋关节置换术并发神经损伤的发生率。我们的研究未证实先前所述的神经损伤与后入路之间的关联。
