全髋关节置换及翻修术后坐骨神经损伤的原因探讨

目的 通过对655例行全髋关节置换及翻修术患者的回顾性分析，探讨术后出现坐骨神经损伤的原因并提出相应的预防措施。方法 1998年1月～2001年12月，对655倒髋关节病变的患者行手术治疗．其中全髋关节置换术587例，全髋关节翻修术68例，术后有9例出现坐骨神经损伤．发生率为1.37％。其中8例发生在全髋关节置换术后，1例发生在全髋关节翻修术后，9例患者中，男3例，女6例；年龄35～67岁，平均51岁，9例患者中4例因股骨头缺血性坏死、2例因先天性髋臼发育不良合并髋关节骨关节炎、1例因强直性脊柱炎合并髋部病变、1例因类风湿关节炎合并髋部病变、1例因全髋关节假体松动而行全髋关节置换术。非骨水泥固定8例，骨水泥固定1例。9例坐骨神经损伤的患者中．7例因肢体不等长而同时行下肢延长术．2例因髋部强直而同时行松解术，结果 9例术后出现坐骨神经损伤的患者．8例为单纯腓总神经损伤．临床表现为足不能背伸；1例为腓总神经和胫神经联合损伤．临床表现为足不能背伸和跖屈。术后随访6～48个月，平均31个月.其中8例患者术后半年坐骨神经功能全部恢复；1例患者术后半年坐骨神经功能仍未恢复．遂行切开探查松解术．探查术后1年坐骨神经功能部分恢复。结论 全髋关节置换及翻修术后坐骨神经损伤．多由下肢过度延长或机械性压迫所致，大多数不完全损伤可以恢复.

Sciatic nerve injury after total hip replacement and total hip revision

Objective The purpose was focused on discussing the causes of sciatic nerve injury following total hip replacement in order to introduce the methods for protecting sciatic nerve during operation by reviewing 655 consecutive total hip replacement and total hip revision. Methods From January 1998 to December 2001, 655 total hip replacement and total hip revision cases were performed in our hospital, 9 cases of which occurred as sciatic nerve injury postoperatively. There were 8 cases in 587 primary total hip replacements and one case in 68 total hip revisions. The 9 patients included 3 males with 3 hips and 6 females with 6 hips with an average age of 51 years ranging from 35 to 67 years old. In the group, 4 cases were diagnosed as avascular necrosis of femoral head, 2 cases as congenital acetabular dysplasia accompanied with osteoarthritis, 1 case as ankylosing spondylitis, 1 case as rheumatoid arthritis and 1 case as loosening of prosthesis. 8 prosthetic components of the hip were fixed by uncement, and the other one was fixed by cement. Results All of the 9 patients experienced sciatic nerve palsy sooner after operation, 8 cases of which suggested simple injury of common peroneal nerve, and 1 case a combined injury of common peroneal nerve and tibial nerve. Of the 9 cases, 7 cases underwent leg lengthening or soft tissue release because of hip joint stiffness during operation. After six to forty-eight months follow-up, the function of sciatic nerve was recovered completely in eight cases after half a year. The other one received total hip revision was not recovered from sciatic never palsy in six months, and the operation of never incision and exploration was performed. During operation, part of the sciatic nerve was found to become thinner without marked compression and other injury. Then release soft tissue around the injured never, the function of sciatic nerve was partly recovered one year after operation. Conclusion It is concluded that sciatic nerve injury associated with total hip arthroplasty is most commonly caused by over-lengthening the low extremity and mechanical compression. The function of sciatic nerve may be recovered in most patients with incomplete injury.