[Intraoperative computer-assisted measurement of stimulation threshold of the common peroneal nerve in osteotomy of the head of the tibia].
Using a computer-assisted threshold hunting paradigm the motoric threshold of the common peroneal nerve was monitored in 18 patients during a high tibial osteotomy (HTO). The exposed nerve (lateral approach) was stimulated proximal to the osteotomy area and the surface EMG of the M. tibialis anterior was used to guide a threshold hunting device. Motoric threshold as a sensitive indicator of nerve function was found to be almost unaffected by several surgical steps of HTO. Only forceful rotation of a subperiostal Hohmann device during high peroneal osteotomy evoked a slight threshold shift that was fully reversible with device repositioning. The tourniquet, however, affected the threshold significantly. In 10 of the 18 patients the nerve became completely inexcitable after an average time of 59 min. The inexcitability was reversible after opening of the tourniquet. On the other hand, the eight patients maintaining an excitability throughout the entire ischemic period had tourniquet times that did not exceed 60 min. There are several factors that may be responsible for the observed inexcitability after long ischemic periods and we conclude that tourniquet time minimization appears appropriate to avoid neurological deficits during a high tibial osteotomy.
Nebelung
W
W
Orthopädische Universitätsklinik, Magdeburg. wolfgang.nebelung@medizin.uni-magdeburg.de
Wissel
H
H
Awiszus
F
F
D000328:Adult; D000368:Aged; D017760:Bone Malalignment / Q000601:surgery*; D004558:Electric Stimulation / Q000295:instrumentation; D004566:Electrodes; D004576:Electromyography / Q000295:instrumentation; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D009046:Motor Neurons / Q000502:physiology*; D010027:Osteotomy; D010543:Peroneal Nerve / Q000098:blood supply / Q000293:injuries* / Q000503:physiopathology; D012680:Sensitivity and Specificity; D012684:Sensory Thresholds / Q000502:physiology; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation*; D013977:Tibia / Q000601:surgery*; D014111:Tourniquets