Hsieh L F, Liaw E S, Cheng H Y, Hong C Z
Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Arch Phys Med Rehabil. 1998 Aug;79(8):1018-21. doi: 10.1016/s0003-9993(98)90104-6.
A case of bilateral femoral neuropathy as a complication of vaginal hysterectomy is presented. A 45-year-old woman developed weakness of both quadriceps, absence of bilateral knee jerks, and numbness over bilateral anteromedial thighs and medial lower legs after a vaginal hysterectomy. Electromyographic examination revealed evidence of denervation in the bilateral quadriceps. A nerve conduction study showed prolonged distal latencies and markedly reduced amplitude of the compound muscle action potentials in bilateral femoral nerves. It is suggested that this complication is caused by a microvascular and/or local mechanical injury of the femoral nerve, which is compressed beneath the tough inguinal ligament in a sustained posture with the hip joint in an extreme abduction and external rotation position. The prognosis was excellent with almost complete recovery within 10 weeks. The complication may be preventable by minimizing operating time, changing the patient's posture, and limiting the degree of flexion, abduction, and external rotation of the hip.
本文报告一例阴道子宫切除术后并发双侧股神经病变的病例。一名45岁女性在阴道子宫切除术后出现双侧股四头肌无力、双侧膝反射消失，以及双侧大腿前内侧和小腿内侧麻木。肌电图检查显示双侧股四头肌存在失神经支配的证据。神经传导研究表明，双侧股神经的远端潜伏期延长，复合肌肉动作电位幅度明显降低。提示该并发症是由于股神经的微血管和/或局部机械性损伤所致，在髋关节处于极度外展和外旋位的持续姿势下，股神经被坚韧的腹股沟韧带压迫。预后良好，10周内几乎完全恢复。通过尽量缩短手术时间、改变患者体位以及限制髋关节的屈曲、外展和外旋程度，可能预防该并发症。
