Ближайшие клинические результаты хирургического лечения пациентов с повреждениями седалищного нерва после тотального эндопротезирования тазобедренного сустава

Abstract

Sciatic nerve (SN) injury associated with total hip arthroplasty (THA) is a challenging issue due to the high prevalence of the complications. However, there is no consensus about the injury mechanism, surgical treatments, indications and timing for the surgeries which necessitates the studies. The objective was To perform a comparative analysis of the dynamics in clinical, neurological and electrophysiological parameters in patients with sciatic nerve injuries associated with THA performing various surgical treatments. Material and methods The study included 61 patients who were hospitalized between 2005 and 2021. Patients were divided into two groups being homogeneous in terms of gender, age and severity of neurological deficit. Microsurgical neurolysis of the sciatic nerve trunk was performed in group I (n = 32) and was added by direct electrical stimulation of the sciatic nerve at the level of injury in group II (n = 29). Clinical, neurological status and electroneuromyography parameters of the patients were assessed preoperatively and at 6 months of surgery. Results All patients showed pain relief with VAS score decreasing from 6 (5.5; 8) to 4 (2; 6) in group I and to 3 (1; 5) in group II (p < 0.001). Functionality of the lower limb scored preoperatively 31 (24.5; 40.5) on the ODI scale in group I and 27 (21; 36) in group II. The patients showed positive dynamics postoperatively with improved lower limb function due to decreased neuropathic pain syndrome scoring 28 (20; 34.5) in group I and 16.5 (8.5; 21.75 ) in group II (p < 0.0001). Conclusions The findings suggested the advantages of the electrical stimulation method in combination with microsurgical neurolysis of the sciatic nerve over the use of microsurgical neurolysis alone with decreased intensity of the pain syndrome and functional insufficiency of the lower limb.