Femoral nerve palsy following Girdlestone resection arthroplasty:An observational cadaveric study  

作　　者：Dominik Spuehler Lukas Kuster Oliver Ullrich Karl Grob 

机构地区：[1]Department of Orthopaedic Surgery and Traumatology,Cantonal Hospital Sankt Gallen,Sankt Gallen 9007,Switzerland [2]Department of Orthopaedics Surgery,Sir Charles Gairdner Hospital,Perth 6009,Western Australia,Australia [3]Institute of Anatomy,University of Zurich,Zurich 8057,Switzerland

出　　处：《World Journal of Orthopedics》2024年第12期1175-1182,共8页世界骨科杂志（英文）

摘　　要：BACKGROUND When patients with a failed hip arthroplasty are unsuitable for reimplantation,Girdlestone resection arthroplasty(GRA)is a viable treatment option.We report on a patient who was treated with a GRA due to a periprosthetic infection.We discovered partial paralysis of the quadriceps muscle in this patient.We investigated the femoral nerve anatomy,particularly the nerve entry points,to better understand this phenomenon.AIM To reveal the femoral nerve anatomy with respect to severe proximal migration after GRA.METHODS Eight cadaveric hemipelves were investigated.The branches of the femoral nerve were dissected and traced distally.The GRA was performed by the direct anterior approach.Axial stress to the lower extremity was applied,and the relative movement of the femur was recorded.The femoral nerve and its entry points were assessed.RESULTS GRA led to a 3.8 cm shift of the femur in vertical direction,a 1.8 cm shift in the dorsal direction,and a 2.3 cm shift in the lateral direction.A 36.5°external shift was observed.This caused stress to the lateral division of the femoral nerve.We observed migration of the femoral nerve entry point at the following locations:(1)Vastus medialis(5.3 mm);(2)The medial part of the vastus intermedius(5.4 mm);(3)The lateral part of the vastus intermedius(16.3 mm);(4)Rectus femoris(23.1 mm);(5)Tensor vastus intermedius(30.8 mm);and(6)Vastus lateralis(28.8 mm).CONCLUSION Migration of the femur after GRA altered the anatomy of the femoral nerve.Stress occurred at the lateral nerve division leading to poor functional results.

关 键 词：Girdlestone resection arthroplasty Resection arthroplasty of the hip Failed hip replacement Femoral nerve palsy Anatomy of the femoral nerve Periprosthetic infection 

分 类 号：R687.3[医药卫生—骨科学]