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DOI: 10.1055/s-2003-812511
Phantomsensationen und peripher induzierter Neglect nach Hüfttotalendoprothese
Phantomsensations and Peripheral Induced Neglect Following Implantation of Total Hip ProsthesisPublikationsverlauf
Publikationsdatum:
10. Februar 2004 (online)
Zusammenfassung
Fragestellung: In seinem Buch „Der Tag an dem mein Bein fortging” schildert O. Sacks selbst erlebt und bei einer Reihe seiner Patienten beobachtet nach Beinverletzungen (u. a. Ruptur der Quadrizepssehne, Schenkelhalsfraktur) eine Unfähigkeit das Bein zu bewegen. Die führt er auf eine Störung der Propriozeption zurück (peripher induzierter Neglect). Die nachfolgende Untersuchung sollte die Frage prüfen, inwieweit und wie häufig sich eine solche Symptomatik postoperativ nachweisen lässt. Methodik: Es wurden 106 Patienten im Alter von 70,35 ± 10,01 Jahren (36 Männer 67,54 ± 9,74 Jahre und 69 Frauen 71,9 ± 9,9 Jahre alt), bei welchen wegen Arthrose (n = 81) oder Oberschenkelhalsfraktur (n = 14) eine Hüfttotalendoprothese (rechts n = 61, links n = 44) mit anterolateralem Zugang nach Watson-Jones implantiert wurde, am 1./2. und am 10. - 14. postoperativen Tag eingehend klinisch neurologisch untersucht und gezielt nach verändertem Empfinden für die operierte Extremität befragt. Ergebnisse: Hinweise für periphere Nervenläsionen als Operationskomplikation fanden sich bei der neurologischen Untersuchung nur selten (1 × N. femoralis, 1 × N. ischiadicus). 14 Patienten gaben bei der Erstuntersuchung ein verändertes Empfinden an: 5 Patienten empfanden ihr operiertes Bein verkleinert oder verkürzt, 3 Patienten empfanden ihr Bein verlängert bzw. vergrößert, 4 Patienten gaben an ihr Bein sei ihnen fremd und fühle sich an wie Holz, Blei oder ein Klotz, 2 Patienten gaben ein Gefühl der Veränderung an, das sie nicht genau beschreiben konnten. Bei der Folgeuntersuchung war das veränderte Empfinden bei keinem der Patienten mehr nachweisbar. Schlussfolgerungen: Bei einer kleinen Zahl von Patienten lässt sich nach einer Hüftoperation vorübergehend eine veränderte Wahrnehmung der operierten Extremität nachweisen, die jedoch bei fehlender Ruhigstellung nicht anhaltend ist. Der von O. Sacks beschriebene peripher induzierte Neglect, lässt sich am ehesten durch eine Abnahme der kortikalen Repräsentation bei längerer Ruhigstellung, nicht jedoch durch eine veränderte Propriozeption erklären.
Abstract
Objectives: O. Sacks describes in his book „A leg to stand on” the inability to move his leg for along period after rupture of the tendon of m. quadriceps. He refers the history of similar cases, especially of a woman with a hip fracture. He discusses this as a result of disruption of proprioception (peripheral induced neglect). The aim of this investigation is to answer the question how frequently this symptom may be found in patients with hip fracture and/or arthrosis perioperativly after implantation of a total prosthesis. Methods: we examined 106 patients aged 70.35 ± 10.01 years (36-male 67.54 ± 9.74 years and 69 female 71.9 ± 9.9 years) who underwent an implantation of a hip prosthesis - antero-lateral access Watson-Jones - (right side n = 61, left n = 44) because of arthrosis (n = 81) or a hip fracture (n = 18) on postoperative day 1./2. and 10. - 14. Besides exact neurologic examination, we particulary asked for changed perception of the operated leg. Results: by neurological examination we found only rarely signs of peripheral nerve lesion as a complication of implantation of hip prosthesis (1 femoral nerve lesion, 1 ischiadicus nerv lesion). 14 patients reported a changed perception at the first examination: 5 patients felt their operated leg shorter or longer, 4 patients described their leg changed in a strange manner (like a block of wood or lead), 2 patients felt their leg changed, but could not tell how. At follow-up examination there was no patient with a changed perception of the operated leg. Conclusions: at first examination only a small number of patients report a changed perception of the operated leg. Early mobilization of the operated leg may be the cause of quick normalization of perception. The peripherally induced neglect, described by O. Sacks, was possibly caused by decrease of cortical representation because of immobilization, but not by disrupted proprioception.
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PD Dr. W.-U. Weitbrecht
Neurologische Klinik/KKH
Wilhelm-Breckow-Allee 20
51643 Gummersbach
eMail: weitbrecht@kkh-gummersbach.de