Short stature and short distance between the anterior acetabular rim to the femoral nerve are risk factors for femoral nerve palsy following primary total hip arthroplasty using the modified Watson-Jones approach
Short stature and short distance between the anterior acetabular rim to the femoral nerve are risk factors for femoral nerve palsy following primary total hip arthroplasty using the modified Watson-Jones approach
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身材矮小和髋臼前缘与股神经之间的距离短是采用改良 Watson-Jones 方法进行初次全髋关节置换术后股神经麻痹的危险因素
DOI：
10.1016/j.otsr.2022.103351
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Okawa Atsushi
中科院分区：
文献类型：
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作者：
Watanabe Naoto;Takada Ryohei;Ogawa Takahisa;Miyatake Kazumasa;Hirao Masanobu;Hoshino Chisato;Jinno Tetsuya;Koga Hideyuki;Yoshii Toshitaka;Okawa Atsushi
全髋关节置换术后神经麻痹严重影响患者的临床功能。然而，很少有研究集中在股神经麻痹（FNP）后，全髋关节置换术通过修改沃森-琼斯的做法。以前的报告表明，THA，无论采用哪种方法，都与几个FNP风险因素相关，包括女性、髋关节发育不良、翻修手术和身材矮小。磁共振成像（MRI）表明，股神经和髋臼前缘（dFN）之间的距离较短与THA后的FNP有关。本研究的目的是：1）通过回顾性调查FNP的临床过程，以确定假定的危险因素，和2）确定FNP的发生和短的dFN之间的关系，通过修改的沃森-琼斯approach.HypothesisShort身材是股神经麻痹后THA。即，在患有和不患有FNP的患者之间存在dFN的显著差异。患者和方法该回顾性病例对照研究在单个大学医院进行。从2016年1月至2020年12月，我们机构通过改良的Watson-Jones方法进行了676例THA。其中495例为仰卧位THA，181例为侧卧位THA。在这项研究中，FNP被定义为股四头肌无力（手动肌肉测试<3级）伴或不伴大腿前内侧感觉障碍。计算FNP的发生率。比较FNP组和非FNP对照组的患者背景因素（年龄、性别、术前诊断、手术位置、身高、体重、体重指数、外科医生经验、组件类型、麻醉方法、手术期间腿部延长和手术时间）。在髋关节中心水平的T1加权MRI轴位图像上测量dFN。在FNP组和非FNP对照组之间，还测量并比较了股神经和髋臼前缘之间的距离，其中牵开器通常在手术期间放置。FNP组和非FNP对照组按患者身高和体重1：4匹配提取。所有数据进行统计学评价，使用Mann-Whitney U检验，andp值小于0.05被认为是statistically significant.ResultsFNP发生在6 676关节（0.88%）以下的主要THA通过修改沃森-琼斯的方法。在所有6例病例中，运动缺陷在一年内完全恢复。FNP组的患者身高显著短于非FNP对照组（148.4 ± 3.3 cm vs. 155.4 ± 8.1 cm [p= 0.01]）。FNP组的dFN明显较短（16.3 ± 4.1 mm vs. 21.5 ± 4.0 mm [p= 0.034]）。结论身材矮小和短dFN是使用改良Watson-Jones方法行THA后FNP的危险因素。证据水平III，病例对照研究。
BackgroundNerve palsy following total hip arthroplasty (THA) critically impacts patient clinical function. However, few studies have focused on femoral nerve palsy (FNP) following THA via the modified Watson-Jones approach. Previous reports have suggested that THA, regardless of the approach, is associated with several FNP risk factors, including female gender, hip dysplasia, revision surgery, and short stature. Magnetic resonance imaging (MRI) has suggested that a shorter distance between the femoral nerve and the anterior acetabular edge (dFN) is related to FNP after THA. The purposes of this study were: 1) to determine the presumed risk factors through a retrospective investigation of FNP clinical courses, and 2) to identify the relationships between FNP occurrence and the short dFN following primary THA via the modified Watson-Jones approach.HypothesisShort stature is a risk factor for femoral nerve palsy following THA. i.e. a significant difference in dFN exists between patients with and without FNP.Patients and methodsThis retrospective case-control study was performed at a single university hospital. From January 2016 to December 2020, 676 THAs were performed via the modified Watson-Jones approach at our institution. These included 495 THAs performed in thesupineposition and 181 in thelateralposition. In this study, FNP was defined as weakness of the quadriceps femoris (manual muscle test < grade 3) with or without sensory disturbance over the anteromedial aspect of the thigh. The incidence of FNP was calculated. Patient background factors (age, sex, preoperative diagnosis, surgical position, height, weight, body mass index, surgeon experience, type of components, the method of anesthesia, leg lengthening during the surgery, and operation time) were compared between the FNP group and a non-FNP control group. The dFN was measured in T1-weighted MRI axial images at the level of the hip center. The distance between the femoral nerve and the anterior acetabular edges, where retractors are commonly placed during surgery, was also measured and compared between the FNP group and the non-FNP control group. The FNP group and non-FNP control group were extracted by 1:4 matching of patient height and weight. All data were statistically evaluated using the Mann-Whitney U test, andpvalues less than 0.05 were considered statistically significant.ResultsFNP occurred in 6 out of 676 joints (0.88%) following primary THA via the modified Watson-Jones approach. In all 6 cases, the motor deficit recovered completely within a year. Patient height was significantly shorter in the FNP group than in the non-FNP control group (148.4 ± 3.3 cm vs. 155.4 ± 8.1 cm [p= 0.01]). The dFN was significantly shorter in the FNP group (16.3 ± 4.1 mm vs. 21.5 ± 4.0 mm [p= 0.034]).ConclusionShort stature and short dFN are risk factors for FNP after THA using the modified Watson-Jones approach.Level of evidenceIII, case-control study.