論文の公開元へA nerve-to-implant distance as a novel predictor for lateral femoral cutaneous nerve injuries after anterior subcutaneous pelvic internal fixation
概要
Anterior external fixation is commonly used for initial stabilization and definitive treatment
of pelvic fractures. Complications such as pin tract infections, osteomyelitis, loosening, loss of
reduction, and difficulty in mobilizing or sitting upright have been reported.1-3 To avoid these
complications associated with external fixators of the anterior pelvis, anterior subcutaneous pelvic
internal fixation (ASPIF) was developed.3,4 The indications for anterior fixation with ASPIF
include AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification 61-B and 61-C
fractures in conjunction with posterior fixation. ASPIF is superior to anterior external fixation in
terms of strength, incidence of infection, patient comfort, and the risk of failure of treatment,
despite the secondary operation (removal of implants) for ASPIF.4
While ASPIF is a valuable tool for reduction and fixation in patients with unstable pelvic ring
injuries, irritation of the lateral femoral cutaneous nerve (LFCN) is one of the most common
complications following ASPIF.4,5 Vaidya et al reported that 30% of patients experienced irritation
of the LFCN after ASPIF.3 The edge of the pedicular screw or rod may irritate or compress the
LFCN during the manipulation and/or insertion of the rod.6 The LFCN is a pure sensory nerve
that is responsible for cutaneous sensation over the anterolateral thigh. LFCN disorders can result
in hypesthesia, pain, or dysesthesia on the anterolateral aspect of the thigh, reportedly causing
a reduction in patients’ quality of life (QOL).7
Although the LFCN-to-implant distance can be a marker that is associated with postoperative
LFCN injuries, there were few reports regarding the LFCN-to-implant distance. Apivatthakakul
et al reported that the average LFCN-to-implant distance was 13.5 ± 1.7 mm (95% confidence
interval [CI] 12.871–14.103) from the lateral end of the rod.6 Reichel et al also reported that
the average LFCN-to-implant distance was 2 cm (95% CI 0.0–0.4). The nerve was adjacent to
the screws in most of the cases (10 of 11 cases).8 However, their measurement of the LFCNto-implant distance may be underestimated due to the absence of tissue turgor and deflation
of blood vessels in their cadaver specimens. Additionally, their cadaver studies did not answer
the question regarding the association between the LFCN-to-implant distance and postoperative
symptoms related to LFCN injury.
Therefore, this study aimed to investigate the utility of an LFCN-to-implant distance of 13
mm, predict postoperative LFCN disorders, and examine the best cut-off point for the LFCNto-implant distance using our cohort. ...
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