Abstract
A preferência dos ortopedistas pela via de acesso póstero-lateral do quadril demanda maior atenção e refinamento da técnica cirúrgica, a fim de diminuir complicações intra e pós-operatórias, principalmente iatrogênicas. Embora o déficit neurológico pós artroplastia de quadril seja uma complicação incomum (cerca de 1%), quase 80% desses casos relacionam-se ao nervo isquiático ou a uma de suas divisões. O objetivo desse estudo foi determinar parâmetros de segurança para a via de acesso póstero-lateral do quadril, visando diminuir a incidência de lesão iatrogênica dos nervos isquiático, tibial ou fibular, uma vez que tal assunto ainda não foi abordado pela literatura. Vinte quadris de cadáveres humanos foram estudados e a menor distância entre o limite lateral do n. isquiático e a inserção do m. piriforme foi 27 mm (aferida sob a margem distal desse músculo), bem como a mínima distância entre o limite lateral do n. isquiático e a inserção femoral do m. quadrado da coxa foi 20mm (aferida sobre a margem proximal desse músculo). A determinação desses parâmetros deixa o ortopedista mais seguro para avançar posterior e distalmente pela via de acesso póstero-lateral, mas não minimiza o cuidado com a dissecção e a importância do emprego de técnica cirúrgica apurada.
Highlights
Since hip arthroplasty has become popular, in the late 1960’s, palsies and paresthesia of ischiatic and fibular nerves are regarded as rare complications, historically reported on a frequency of 0.5% - 2.0%(1,2,3)
The posterolateral access port to the hip is the most commonly used one by orthopaedic surgeons in hip arthroplasties[7], enabling us to infer that accesses through this port and the occurrence of ischiatic nerve damage are correlated
Studies conducted so far have addressed the frequency of nervous injuries in that population, there is no objective description of anatomical safety margins, i.e., distances that, when complied with, would reflect low or no incidence of iatrogenic nerve damage
Summary
Since hip arthroplasty has become popular, in the late 1960’s, palsies and paresthesia of ischiatic and fibular nerves are regarded as rare complications, historically reported on a frequency of 0.5% - 2.0%(1,2,3). According to Schmalzried et al[6] the prevalence of neurological deficit after a hip arthroplasty is approximately 1% (0.08% - 7.6%), with almost 80% of these cases being correlated to ischiatic nerve or one of its divisions (ischiatic nerve: 27.2%, tibial nerve: 0.4%, fibular nerve: 51.9%). Studies conducted so far have addressed the frequency of nervous injuries in that population, there is no objective description of anatomical safety margins, i.e., distances that, when complied with, would reflect low or no incidence of iatrogenic nerve damage. Addressing the correlation between nervous injury and access port, the objective of the present study was to assess anatomical parameters in cadavers and to determine a safety zone for posterolateral access to the hip so as to reduce the incidence and prevalence of ischiatic nerve injuries during a surgical procedure
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