Yesterday, a netizen asked me: “Dr. Wang, I have a problem with my hip joint. The local doctor told me that I need a total hip replacement. However, my left leg is 3cm shorter than the right side. The operation will cause nerves. Damage?"
Today, I will introduce some problems of nerve damage during total hip replacement surgery.
Which nerves may be damaged by hip replacement?
To answer the above questions, we need to first look at the neuroanatomy around the hip joint, as shown below:
The main nerves around the hip joint are: the femoral nerve in the front and the sciatic nerve in the back. Nerve damage is mainly caused by these two nerves. Of course, there are also reports of obturator nerve, common peroneal nerve and gluteal epithelial nerve. Because of the small proportion, we will not discuss it for the time being.
According to reports in the literature, nerve damage caused by artificial hip replacement is rare, and the incidence is only 1%~2%. Among them, the femoral nerve and sciatic nerve are more common. The sciatic nerve accounts for 79% and the femoral nerve accounts for 13%. The combined injury of the sciatic nerve and femoral nerve accounted for 6%, and the obturator nerve accounted for 1.6%.
Why during hip replacementWill there be nerve damage?
The nerve damage during hip replacement is mainly caused by the following reasons:p>
1. Nerve traction: The question asked by netizens at the beginning of the article is actually to ask when the hip joints are not equal in length, if the shorter side of the hip joint is replaced, you need to do To the same length of both lower limbs, stretch more thanCan cause nerve damage in a short time? Our answer is that more than 4cm may cause nerve damage. Therefore, the netizen’s affected limb is 3cm short, and it is not easy to cause nerve traction. Of course, the causes of nerve traction injuries include: poor placement of the limbs during the operation.
2. Contusion: Contusion causes nerve damage during hip replacement surgery, including improper placement of the hook during surgery, improper operation of intraoperative coagulation, resulting in nerve burns and bone cement heating Heat burns and so on.
3. Hematoma compression: When the operation is not carefully stopped, the patient has blood problems and other reasons, hematoma compression during the operation can also cause nerve damage during hip replacement surgery.
4. Dislocation: Hip offDuring arthroplasty, it is necessary to remove the original femoral head after dislocation of the hip joint and install a new prosthesis. Improper dislocation during this process will cause intraoperative nerve damage.
5. Direct injury: Direct injury during hip replacement is very rare. Skilled doctors are very familiar with anatomy, and these nerves are visible to the naked eye. Therefore, the probability of direct injury is not Not big.
According to literature reports, the main cause of nerve injury in hip replacement is 20%, contusion 19%, hematoma compression 11%, dislocation 2%, and direct injury 1 %.
Sciatic nerve injury and prevention:
The sciatic nerve exits the pelvis from the lower edge of the piriformis muscle and runs behind the hip joint.During hip replacement Most of the sciatic nerve injuries are caused by improper surgical operations.
Under normal circumstances, we do not need to expose the sciatic nerve during joint replacement surgery, but when the hip joint changes, the acetabulum In order to avoid damaging the nerve during the deformity healing of the fracture and the revision operation, we must expose the sciatic nerve, protect it, and then perform the operation.ForFor patients at high risk of sciatic nerve injury, we can adopt a knee flexion position during the operation to reduce nerve tension and perform intraoperative EMG monitoring if necessary.
For patients with hip dislocation, the degree of nerve damage that may be caused by the dislocation is related to the compression time of the nerve, Therefore, we advocate resetting as soon as possible to prevent and reduce the degree of nerve damage .
For patients with hematoma compression, internal fixation compression such as screws and wires, we should also advocate nerve exploration as soon as possible and relieve nerve compression.
According to literature reports, 85% of sciatic nerve injuries can be recovered to a certain extent after good treatment. For patients with early partial recovery of motor function, it usually indicates a good prognosis.
Femoral nerve injuryand prevention:
The femoral nerve injury is less than the sciatic nerve injury. The femoral nerve is located in the femoral triangle in front of the hip joint and runs in front of the hip joint. In most cases, femoral nerve injury during hip replacement is caused by improper surgical operation.
Generally, when we do anterior hip replacement surgery, the femoral nerve will be damaged due to improper use of the retractor and removal of the adhesive anterior joint capsule. Among them, the thigh caused by the improper use of the acetabular anterior plate retractor Nerve damage is most common. During the operation, care should be taken when placing the acetabular anterior plate retractor. The inclination angle of 45° can be maintained to avoid the retractor reaching the inside.
Because the femoral nerve is located in the femoral triangle in front of the hip joint, a small amount of bleeding can cause compression due to the narrow space of the femoral triangle. Thus, it is important to stop bleeding carefully.
According to the literature, the prognosis of femoral nerve injury after hip replacement is better than that of sciatic nerve injury.
The probability of nerve injury during hip replacement is not high. Among them, sciatic nerve injury and femoral nerve injury The probability of injury is the greatest. Usually these injuries are caused by improper surgery. Early treatment and good prognosis. But prevention work should still be done. Netizens worry about whether the hip replacement with a 3cm shortened limb may cause nerve traction injury. You can rest assured that 4cm or more is a high-risk patient.By.