Abstract：
OBJECTIVE: To identify factors that contribute to iatrogenic sciatic nerve palsy during acetabular surgery through a Kocher-Langenbeck approach and to evaluate if variation among individual surgeons exists.
METHODS:
METHODS: Retrospective cohort.
METHODS: Level I trauma center.
UNASSIGNED: Adults undergoing fixation of acetabular fractures (AO/OTA 62) through a posterior approach by 9 orthopaedic traumatologists between November 2010 and November 2022.
UNASSIGNED: The prevalence of iatrogenic sciatic nerve palsy and comparison of the prevalence and risk of palsy between prone and lateral positions before and after adjusting for individual surgeon and the presence of transverse fracture patterns in logistic regression. Comparison of the prevalence of palsy between high-volume (>1 patient/month) and low-volume surgeons.
RESULTS: A total of 644 acetabular fractures repaired through a posterior approach were included (median age 39 years, 72% male). Twenty of 644 surgeries (3.1%) resulted in iatrogenic sciatic nerve palsy with no significant difference between the prone (3.1%, 95% confidence interval [CI], 1.9%-4.9%) and lateral (3.3%, 95% CI, 1.3%-8.1%) positions (P = 0.64). Logistic regression adjusting for surgeon and transverse fracture pattern demonstrated no significant effect for positions (odds ratio 1.0, 95% CI, 0.3-3.9). Transverse fracture pattern was associated with increased palsy risk (odds ratio 3.0, 95% CI, 1.1-7.9). Individual surgeon was significantly associated with iatrogenic palsy (P < 0.02).
CONCLUSIONS: Surgeon and the presence of a transverse fracture line predicted iatrogenic nerve palsy after a posterior approach to the acetabulum in this single-center cohort. Surgeons should perform the Kocher-Langenbeck approach for acetabular fixation in the position they deem most appropriate, as the position was not associated with the rate of iatrogenic palsy in this series.
METHODS: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
METHODS:
METHODS: Retrospective cohort.
METHODS: Level I trauma center.
UNASSIGNED: Adults undergoing fixation of acetabular fractures (AO/OTA 62) through a posterior approach by 9 orthopaedic traumatologists between November 2010 and November 2022.
UNASSIGNED: The prevalence of iatrogenic sciatic nerve palsy and comparison of the prevalence and risk of palsy between prone and lateral positions before and after adjusting for individual surgeon and the presence of transverse fracture patterns in logistic regression. Comparison of the prevalence of palsy between high-volume (>1 patient/month) and low-volume surgeons.
RESULTS: A total of 644 acetabular fractures repaired through a posterior approach were included (median age 39 years, 72% male). Twenty of 644 surgeries (3.1%) resulted in iatrogenic sciatic nerve palsy with no significant difference between the prone (3.1%, 95% confidence interval [CI], 1.9%-4.9%) and lateral (3.3%, 95% CI, 1.3%-8.1%) positions (P = 0.64). Logistic regression adjusting for surgeon and transverse fracture pattern demonstrated no significant effect for positions (odds ratio 1.0, 95% CI, 0.3-3.9). Transverse fracture pattern was associated with increased palsy risk (odds ratio 3.0, 95% CI, 1.1-7.9). Individual surgeon was significantly associated with iatrogenic palsy (P < 0.02).
CONCLUSIONS: Surgeon and the presence of a transverse fracture line predicted iatrogenic nerve palsy after a posterior approach to the acetabulum in this single-center cohort. Surgeons should perform the Kocher-Langenbeck approach for acetabular fixation in the position they deem most appropriate, as the position was not associated with the rate of iatrogenic palsy in this series.
METHODS: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
摘要：
目的：通过Kocher-Langenbeck方法确定髋臼手术中导致医源性坐骨神经麻痹的因素，并评估个别外科医生之间是否存在差异。
方法：
方法：回顾性队列。
方法：一级创伤中心。
■在2010年11月至2022年11月期间，由9名骨科创伤学家通过后路对髋臼骨折（AO/OTA62）进行固定的成年人。
■医源性坐骨神经麻痹的患病率以及在调整个体外科医生前后俯卧位和侧卧位之间的麻痹患病率和风险的比较，以及在逻辑回归中是否存在横向骨折模式。高容量（>1名患者/月）和低容量外科医生之间的麻痹患病率比较。
结果：共纳入644例通过后路修复的髋臼骨折（中位年龄39岁，72%男性）。644例手术中有20例（3.1％）导致医源性坐骨神经麻痹，俯卧之间没有显着差异（3.1％，95%置信区间[CI]，1.9%-4.9%）和横向（3.3%，95%CI，1.3%-8.1%）位置（P=0.64）。对外科医生和横向骨折模式进行逻辑回归调整后，对位置没有显着影响（比值比1.0，95％CI，0.3-3.9）。横向骨折模式与麻痹风险增加相关（比值比3.0，95％CI，1.1-7.9）。个别外科医生与医源性麻痹显著相关(P<0.02)。
结论：在这个单中心队列中，外科医生和横向骨折线的存在预测了髋臼后入路手术后的医源性神经麻痹。外科医生应在他们认为最合适的位置进行Kocher-Langenbeck入路髋臼固定，因为该位置与本系列中医源性麻痹的发生率无关。
方法：预后III级。有关证据级别的完整描述，请参阅作者说明。
方法：
方法：回顾性队列。
方法：一级创伤中心。
■在2010年11月至2022年11月期间，由9名骨科创伤学家通过后路对髋臼骨折（AO/OTA62）进行固定的成年人。
■医源性坐骨神经麻痹的患病率以及在调整个体外科医生前后俯卧位和侧卧位之间的麻痹患病率和风险的比较，以及在逻辑回归中是否存在横向骨折模式。高容量（>1名患者/月）和低容量外科医生之间的麻痹患病率比较。
结果：共纳入644例通过后路修复的髋臼骨折（中位年龄39岁，72%男性）。644例手术中有20例（3.1％）导致医源性坐骨神经麻痹，俯卧之间没有显着差异（3.1％，95%置信区间[CI]，1.9%-4.9%）和横向（3.3%，95%CI，1.3%-8.1%）位置（P=0.64）。对外科医生和横向骨折模式进行逻辑回归调整后，对位置没有显着影响（比值比1.0，95％CI，0.3-3.9）。横向骨折模式与麻痹风险增加相关（比值比3.0，95％CI，1.1-7.9）。个别外科医生与医源性麻痹显著相关(P<0.02)。
结论：在这个单中心队列中，外科医生和横向骨折线的存在预测了髋臼后入路手术后的医源性神经麻痹。外科医生应在他们认为最合适的位置进行Kocher-Langenbeck入路髋臼固定，因为该位置与本系列中医源性麻痹的发生率无关。
方法：预后III级。有关证据级别的完整描述，请参阅作者说明。
