膝关节置换术后皮肤麻痹的解剖基础及相关临床研究

doi:10.13418/j.issn.1001-165x.2016.02.001

中国临床解剖学杂志 ›› 2016, Vol. 34 ›› Issue (2): 121-125.doi: 10.13418/j.issn.1001-165x.2016.02.001

• 应用解剖 • 下一篇

膝关节置换术后皮肤麻痹的解剖基础及相关临床研究

高兴华^1,2，　刘永轶²，　王敏聪²，　张光明²，　侯之启²

1.暨南大学附属第一医院骨科，广州 510630； 2.广州市第一人民医院关节外科，广州 510180

收稿日期:2015-12-15 出版日期:2016-03-25 发布日期:2016-04-14
通讯作者: 侯之启，主任医师，教授，E-mail：smilehouzq@163.com
作者简介:高兴华（1979-），男，江西赣州人，副主任医师，主要从事关节疾病治疗，在人工关节置换手术及修复重建方面深入研究，E-mail：56065546@qq.com

The anatomical study of infrapatellar branch of the saphenous nerve and design of a modified incision to decrease numbness following total knee arthroplasty

GAO Xing-hua ^1,2, LIU Yong-yi ², WANG Min-cong ², ZHANG Guang-ming ², HOU Zi-qi ²

Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China; Department of Orthopedics, Guangzhou First People’s Hospital, Guangzhou 510180, China

Received:2015-12-15 Online:2016-03-25 Published:2016-04-14

摘要/Abstract

摘要：

目的　探讨膝关节置换术后隐神经髌下支损伤所致的皮肤麻痹的解剖基础，改良手术切口，减少膝前皮肤麻木并发症。方法　解剖观察12例成人尸体下肢标本，观测隐神经髌下支形态、神经束的走行及毗邻关系。设计改良膝外侧皮肤切口行膝关节置换手术入路进行临床验证，比较术后效果。结果　解剖研究发现隐神经髌下支自缝匠肌穿出后，标本在髌骨中心平面神经距髌骨内侧缘约3.2 cm，75%标本有3束分支分布于髌骨下极及胫骨粗隆区域，以髌骨下极与粗隆连线中点为中心作圆，神经纤维主要分布左侧在第2象限，右侧在第1象限。临床研究采用改良膝关节外侧切口行膝关节置换术15例，方法可行，术后膝前皮肤麻木的发生率及范围较对照组减少，有统计学意义。结论　根据膝关节隐神经髌下支解剖分布特点，改良膝前皮肤切口行膝关节置换术可减少术后膝前麻木。

关键词: 隐神经髌下支, 膝关节置换术, 皮肤麻痹, 切口

Abstract:

Objective　To explore the infrapatellar branch of the saphenous nerve (IPBSN) that is apt to be injured during total knee arthroplasty (TKA), leading to numbness in its area of distribution, and modify the incision of TKA to decrease numbness.　Methods　12 cadaveric knees were dissected, the origin of the nerve was traced in relation with the sartouius muscle and the knee anatomy mark, the course and terminal branches of the nerve were observed and recorded. Then a modified knee lateral incision for TKA was designed, and the results were collected and compared with the med-line incision group.　Results　The nerve was found to the emerge near the anterior border of sartorius muscle, with a distance to the medial margin of the patella being 3.2 cm. In a majority of the cases (75%), there were 3 branches between the apex of patella and tibial tuberosity; in the center of the patella tendon, a coordinate system was made, and the majority of the nerve fibers lied in the first quartile of the right knee, and in the second quartile of the left knee. 15 TKA cases were performed using the modified lateral incision. The surgery was uneventful, and the post-operation numbness rate and scope were significantly reduced than in the control group.　Conclusion　By enriching the knowledge of these variable anatomical position of the IPBSN, an modified lateral incision for TKA with reduced incidence of numbness is feasible and valuable.

Key words: Infrapatellar branch(IPBSN), Total knee arthroplasty(TKA), Numbness, Incision

高兴华,刘永轶,王敏聪,张光明,侯之启. 膝关节置换术后皮肤麻痹的解剖基础及相关临床研究 [J]. 中国临床解剖学杂志, 2016, 34(2): 121-125.

GAO Xing-hua, LIU Yong-yi, WANG Min-cong, ZHANG Guang-ming, HOU Zi-qi. The anatomical study of infrapatellar branch of the saphenous nerve and design of a modified incision to decrease numbness following total knee arthroplasty[J]. Chinese Journal Of Clinical Anatomy, 2016, 34(2): 121-125.

参考文献

[1] Borley NR, Edwards D, Villar RN. Lateral skin flap numbness after total knee arthroplasty[J]. J Arthroplasty, 1995, 10(1): 13-14.
[2] Hopton BP, Tommichan MC, Howell FR. Reducing lateral skin flap numbness after total knee arthroplasty[J]. Knee, 2004, 11(4): 289-291.
[3] Johnson DF, Love DT, Love BR, et al. Dermal hypoesthesia after total knee arthroplasty[J]. Am J Orthop, 2000, 29(11): 863-866.
[4] Sundaram RO, Ramakrishnan M, Harvey RA, et al. Comparison of scars and resulting hypoaesthesia between the medial parapatellar and midline skin incisions in total knee arthroplasty[J]. Knee, 2007, 14(5): 375-378.
[5] Black R,Green C,Sochart D. Postoperative numbness of the knee following total knee arthroplasty[J]. Ann R Coll Surg Engl, 2013, 95(8):565-568.
[6] Tennent TD, Birch NC, Holmes MJ, et al. Knee pain and the infrapatellar branch of the saphenous nerve[J]. J R Soc Med, 1998,91(11): 573-575.
[7] Kerver A,Leliveld MS,Hartog D,et al.The surgical anatomy of the infrapatellar branch of the saphenous nerve in relation to incisions for anteromedial knee surgery[J]. J Bone Joint Surg Am, 2013,95(23): 2119-2125.
[8] 余正红，蔡胥，赵卫东，等. 膝关节神经分布的解剖学研究及其临床意义[J]. 中国临床解剖学杂志, 2008, 26(1):11-16.
[9] Ebraheim NA, Mekhail AO.The infrapatellar branch of the saphenous nerve: an anatomic study[J]. J Orth Trauma, 1997, 11(3): 195-199.
[10]Kalthur SG, Sumalatha S, Nair N,et al. Anatomic study of infrapatellar branch of saphenous nerve in male cadavers[J]. Ir J Med Sci, 2015, 184(1): 201-206.
[11]Laffosse JM, Potapov A, Michel M, et al. Hypesthesia after Anterolateral versus Midline Skin Incision in TKA: A Randomized Study[J]. Clin Orthop Relat Res, 2011, 469: 3154-3163.
[12]Mǖller W. The Knee: Form, Function and Ligament Reconstruction[M].Heidelberg, Germany, Springer-Verlag, 1983.

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膝关节置换术后皮肤麻痹的解剖基础及相关临床研究

The anatomical study of infrapatellar branch of the saphenous nerve and design of a modified incision to decrease numbness following total knee arthroplasty

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