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 ...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.展开更多
We encountered a patient who developed femoral nerve paralysis due to iliopsoas muscle hematoma. Surgical removal of the hematoma is recommended for such cases, but conservative treatment may also be sufficient and th...We encountered a patient who developed femoral nerve paralysis due to iliopsoas muscle hematoma. Surgical removal of the hematoma is recommended for such cases, but conservative treatment may also be sufficient and there are no clear judgment criteria. An investigation of past reports showed that recovery was faster after surgery than after conservative treatment, regardless of the severity of paralysis, and that hematoma removal was especially effective for cases with severe paralysis. In our case, pain of the femoral nerve-innervated region was rapidly relieved by removal of the hematoma.展开更多
BACKGROUND Intracranial hypotension(IH)is a disorder involving cerebrospinal fluid(CSF)hypovolemia due to spontaneous or traumatic spinal CSF leakage and is easily being misdiagnosed or missed,especially in these pati...BACKGROUND Intracranial hypotension(IH)is a disorder involving cerebrospinal fluid(CSF)hypovolemia due to spontaneous or traumatic spinal CSF leakage and is easily being misdiagnosed or missed,especially in these patients without the prototypical manifestation of an orthostatic headache.At present,the management of IH with both cranial nerve VI palsy and bilateral subdural hematomas(SDHs)is still unclear.CASE SUMMARY A 67-year-old male Chinese patient complained of diplopia on the left side for one and a half mo.Computed tomography revealed bilateral SDHs and a midline shift.However,neurotrophic drugs were not effective,and 3 d after admission,he developed a non-orthostatic headache and neck stiffness.Enhanced magnetic resonance imaging revealed dural enhancement as an additional feature,and IH was suspected.Magnetic resonance myelography was then adopted and showed CSF leakage at multiple sites in the spine,confirming the diagnosis of having IH.The patient fully recovered following multiple targeted epidural blood patch(EBP)procedures.CONCLUSION IH is a rare disease,and to the best of our knowledge,IH with diplopia as its initial and primary symptom has never been reported.In this study,we also elucidated that it could be safe and effective to treat IH patients with associated cranial nerve VI palsy and bilateral SDHs using repeated EBP therapy.展开更多
文摘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.
文摘We encountered a patient who developed femoral nerve paralysis due to iliopsoas muscle hematoma. Surgical removal of the hematoma is recommended for such cases, but conservative treatment may also be sufficient and there are no clear judgment criteria. An investigation of past reports showed that recovery was faster after surgery than after conservative treatment, regardless of the severity of paralysis, and that hematoma removal was especially effective for cases with severe paralysis. In our case, pain of the femoral nerve-innervated region was rapidly relieved by removal of the hematoma.
文摘目的探讨沙滩椅体位下行肩关节手术后发生股外侧皮神经麻痹(lateral femoral cutaneous nerve palsy,LFCNP)的危险因素。方法回顾性分析254例沙滩椅体位下行肩关节手术患者的临床资料。根据患者术后是否发生LFCNP分为LFCNP组(8例)和非LFCNP组(246例),记录比较2组患者的人口统计学特征、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、术前合并症(高血压史、2型糖尿病史)、麻醉方法、围术期输液量、尿量、出血量、手术时间。将单因素方差分析中差异有统计学意义的指标纳入二元Logistic回归,分析沙滩椅体位下行肩关节手术后发生LFCNP的危险因素。结果LFCNP组体重指数(body mass index,BMI)明显大于非LFCNP组,手术时间明显长于非LFCNP组,差异均有统计学意义(P<0.05)。2组性别、年龄、身高、体重、ASA分级、术前并发症(高血压史、2型糖尿病史)、麻醉方法、输注液量、尿量、失血量差异均无统计学意义(P>0.05)。Logistic回归分析结果显示,BMI>28和手术时间>2 h是沙滩椅体位下行肩关节手术后发生LFCNP的危险因素。结论BMI>28和手术时间>2 h是沙滩椅体位下行肩关节手术后发生LFCNP的危险因素。
文摘BACKGROUND Intracranial hypotension(IH)is a disorder involving cerebrospinal fluid(CSF)hypovolemia due to spontaneous or traumatic spinal CSF leakage and is easily being misdiagnosed or missed,especially in these patients without the prototypical manifestation of an orthostatic headache.At present,the management of IH with both cranial nerve VI palsy and bilateral subdural hematomas(SDHs)is still unclear.CASE SUMMARY A 67-year-old male Chinese patient complained of diplopia on the left side for one and a half mo.Computed tomography revealed bilateral SDHs and a midline shift.However,neurotrophic drugs were not effective,and 3 d after admission,he developed a non-orthostatic headache and neck stiffness.Enhanced magnetic resonance imaging revealed dural enhancement as an additional feature,and IH was suspected.Magnetic resonance myelography was then adopted and showed CSF leakage at multiple sites in the spine,confirming the diagnosis of having IH.The patient fully recovered following multiple targeted epidural blood patch(EBP)procedures.CONCLUSION IH is a rare disease,and to the best of our knowledge,IH with diplopia as its initial and primary symptom has never been reported.In this study,we also elucidated that it could be safe and effective to treat IH patients with associated cranial nerve VI palsy and bilateral SDHs using repeated EBP therapy.
